Healthcare Provider Details

I. General information

NPI: 1629545967
Provider Name (Legal Business Name): COLLEEN BELEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 MAIN ST
PEEKSKILL NY
10566-2505
US

IV. Provider business mailing address

1827 MAIN ST
PEEKSKILL NY
10566-2505
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-3728
  • Fax:
Mailing address:
  • Phone: 914-737-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: