MEDICARE: DENISE COLLETTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	419788	NY

General Provider Information

NPI Number	:	1063973113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE COLLETTA

Provider Business Mailing Address
First Line	:	110 LONGVIEW AVE
Second Line	:
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-9117
Country	:	US
Telephone Number	:	347-665-4752
Fax Number	:	929-208-4517

Provider Business Practice Location Address
First Line	:	110 LONGVIEW AVE
Second Line	:
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-9117
Country	:	US
Telephone Number	:	347-665-4752
Fax Number	:	929-208-4517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	03/29/2019

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Directions to “ DENISE COLLETTA ” Practice Location

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