Healthcare Provider Details

I. General information

NPI: 1508958141
Provider Name (Legal Business Name): CLAIRE DIANE KOLENSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BERG AVE
KINGS PARK NY
11754-1503
US

IV. Provider business mailing address

64 BERG AVE
KINGS PARK NY
11754-1503
US

V. Phone/Fax

Practice location:
  • Phone: 631-742-9099
  • Fax:
Mailing address:
  • Phone: 631-742-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number213402
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: