Healthcare Provider Details

I. General information

NPI: 1639257835
Provider Name (Legal Business Name): HRISTO NIKOLA COLAKOVSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 RIDGE RD E SUITE 1B
ROCHESTER NY
14622-2473
US

IV. Provider business mailing address

1880 RIDGE RD E SUITE 1B
ROCHESTER NY
14622-2473
US

V. Phone/Fax

Practice location:
  • Phone: 585-266-7540
  • Fax: 585-266-7406
Mailing address:
  • Phone: 585-266-7540
  • Fax: 585-266-7406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number208580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: