Healthcare Provider Details

I. General information

NPI: 1982613634
Provider Name (Legal Business Name): COLLEEN DALY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N. VILLAGE AVENUE
ROCKVILLE CENTRE NY
11571
US

IV. Provider business mailing address

112 HILTON AVE
GARDEN CITY NY
11530
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-1353
  • Fax:
Mailing address:
  • Phone: 516-410-1563
  • Fax: 516-246-9437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number230896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: