Healthcare Provider Details

I. General information

NPI: 1154370245
Provider Name (Legal Business Name): STEPHEN ROBERT COLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 PARK AVE
NEW YORK NY
10021-4251
US

IV. Provider business mailing address

742 PARK AVE
NEW YORK NY
10021-4251
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-8900
  • Fax: 212-772-1308
Mailing address:
  • Phone: 212-988-8900
  • Fax: 212-772-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number137908
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: