Healthcare Provider Details

I. General information

NPI: 1114089430
Provider Name (Legal Business Name): MICHAEL LAWRENCE KOLIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 FASHION AVE SUITE 1404-A
NEW YORK NY
10018-4603
US

IV. Provider business mailing address

18 FROST POND DR
ROSLYN NY
11576-2808
US

V. Phone/Fax

Practice location:
  • Phone: 212-768-7979
  • Fax: 212-768-1223
Mailing address:
  • Phone: 917-533-3083
  • Fax: 212-768-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX009639-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: