Healthcare Provider Details

I. General information

NPI: 1770019895
Provider Name (Legal Business Name): BORA COLAK M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 5TH AVE APT 1BB
NEW YORK NY
10003-4692
US

IV. Provider business mailing address

777 SEAVIEW AVE
STATEN ISLAND NY
10305-3409
US

V. Phone/Fax

Practice location:
  • Phone: 917-656-1955
  • Fax:
Mailing address:
  • Phone: 718-667-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number307504
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number307504
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: