Healthcare Provider Details

I. General information

NPI: 1720113137
Provider Name (Legal Business Name): COLLEEN VATALARO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LOCUST AVE
OAKDALE NY
11769-1651
US

IV. Provider business mailing address

3 ROGERS ST
BLUE POINT NY
11715-2006
US

V. Phone/Fax

Practice location:
  • Phone: 631-567-3320
  • Fax: 631-567-3285
Mailing address:
  • Phone: 631-363-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number256103-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: