Healthcare Provider Details

I. General information

NPI: 1982574513
Provider Name (Legal Business Name): KATHLEEN COLBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2025
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 76TH AVE
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

270 OAKLAND AVE
DEER PARK NY
11729-5946
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-4780
  • Fax:
Mailing address:
  • Phone: 631-624-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number795968-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: