Healthcare Provider Details

I. General information

NPI: 1891782777
Provider Name (Legal Business Name): STEVEN COLBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

PO BOX 5450
NEW YORK NY
10087-5450
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-5246
  • Fax: 718-780-3259
Mailing address:
  • Phone: 718-780-5246
  • Fax: 718-780-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME0076743
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number157414
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: