1033279583 NPI number — THOMAS M COLLINS M.D.

Table of content: THOMAS M COLLINS M.D. (NPI 1033279583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033279583 NPI number — THOMAS M COLLINS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
THOMAS
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033279583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 DAVENPORT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10573-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-967-9383
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 NORTH AVE
Provider Second Line Business Practice Location Address:
NEW ROCHELLE SERVICES OF RPC SECOND FLOOR
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801-4160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-633-8842
Provider Business Practice Location Address Fax Number:
914-633-8947
Provider Enumeration Date:
12/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  146384 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13D423 . This is a "BC BS HOSPITAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 13D422 . This is a "BC BS PRIVATE PRACTICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".