Healthcare Provider Details

I. General information

NPI: 1629036082
Provider Name (Legal Business Name): LAURA C COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

39 WACHUSETT RD
NEEDHAM MA
02492-3922
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2700
  • Fax:
Mailing address:
  • Phone: 617-667-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number338415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: