Healthcare Provider Details

I. General information

NPI: 1700818143
Provider Name (Legal Business Name): RONALD LEOPOLD COLLINS M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7616 BAY PKWY SUITE # 1
BROOKLYN NY
11214-1516
US

IV. Provider business mailing address

7616 BAY PKWY SUITE # 1
BROOKLYN NY
11214-1516
US

V. Phone/Fax

Practice location:
  • Phone: 718-837-7400
  • Fax: 718-837-7402
Mailing address:
  • Phone: 718-837-7400
  • Fax: 718-837-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number148910
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: