Healthcare Provider Details

I. General information

NPI: 1407668239
Provider Name (Legal Business Name): COLBY KUSINITZ EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 OLD COUNTRY RD
PLAINVIEW NY
11803-4980
US

IV. Provider business mailing address

885 OLD COUNTRY RD
PLAINVIEW NY
11803-4980
US

V. Phone/Fax

Practice location:
  • Phone: 516-200-1054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number471737
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: