1972599645 NPI number — DR. EILEEN FRANCES COLLIGAN M.D.

Table of content: DR. EILEEN FRANCES COLLIGAN M.D. (NPI 1972599645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972599645 NPI number — DR. EILEEN FRANCES COLLIGAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLIGAN
Provider First Name:
EILEEN
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1972599645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 987
Provider Second Line Business Mailing Address:
21 ORCHARD STREET
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10940-5004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-343-7614
Provider Business Mailing Address Fax Number:
845-343-5390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 GIBSON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-291-0100
Provider Business Practice Location Address Fax Number:
845-343-5390
Provider Enumeration Date:
09/27/2005

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: 207R00000X , with the licence number:  125788 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: 125788 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: SERIAL # 001120 . This is a "USCG CERTIFICATE OF REGISTRY - MEDICAL DOCTOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00399284 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125788 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA0414310 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1306096318 . This is a "GROUP ORGANIZATION NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10507901 . This is a "CAQH PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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