Healthcare Provider Details

I. General information

NPI: 1841969185
Provider Name (Legal Business Name): COLLEEN MARY CAHILL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

260 E 67TH ST
NEW YORK NY
10065-6212
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-9516
  • Fax:
Mailing address:
  • Phone: 212-629-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: