1376578997 NPI number — DR. MICHELE SUMMERS COLON D.P.M.

Table of content: DR. MICHELE SUMMERS COLON D.P.M. (NPI 1376578997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376578997 NPI number — DR. MICHELE SUMMERS COLON D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLON
Provider First Name:
MICHELE
Provider Middle Name:
SUMMERS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLON
Provider Other First Name:
MICHELE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1376578997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 CORNELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED HOOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12571-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-315-5434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 OLD LOUDON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-608-4587
Provider Business Practice Location Address Fax Number:
518-608-4768
Provider Enumeration Date:
07/12/2006

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: 213ES0103X , with the licence number:  E4053 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: N007219 , 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: 990005019 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000E40530 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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