Healthcare Provider Details

I. General information

NPI: 1578758629
Provider Name (Legal Business Name): CHRISTOPHER COLLADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST NEW YORK HOSPITAL DEPT OF ANESTHESIOLOGY
FLUSHING NY
11355-5095
US

IV. Provider business mailing address

13420 87TH AVE APT 3E
JAMAICA NY
11418-1953
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1080
  • Fax: 718-670-2597
Mailing address:
  • Phone: 718-658-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number246080
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: