Healthcare Provider Details

I. General information

NPI: 1104832302
Provider Name (Legal Business Name): COLLEEN M. FAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5814
  • Fax: 718-579-3929
Mailing address:
  • Phone: 718-518-5814
  • Fax: 718-579-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number163795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: