Healthcare Provider Details

I. General information

NPI: 1902858319
Provider Name (Legal Business Name): BRIAN IRA COLLET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8439 153RD AVE SUITE LM
HOWARD BEACH NY
11414-1957
US

IV. Provider business mailing address

8439 153RD AVE SUITE LM
HOWARD BEACH NY
11414-1957
US

V. Phone/Fax

Practice location:
  • Phone: 718-848-3909
  • Fax:
Mailing address:
  • Phone: 718-848-3909
  • Fax: 718-848-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number146921-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number146921-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: