Healthcare Provider Details

I. General information

NPI: 1306453113
Provider Name (Legal Business Name): COLLEEN ELLEN ZYLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 11/27/2023
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WESTCHESTER AVE STE S638
RYE BROOK NY
10573-1331
US

IV. Provider business mailing address

4 ELSIE CIR
CORNWALL ON HUDSON NY
12520-1231
US

V. Phone/Fax

Practice location:
  • Phone: 855-284-9191
  • Fax:
Mailing address:
  • Phone: 914-588-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1103X
TaxonomyMilitary Ambulatory Procedure Visits Operational (Transportable) Clinic/Center
License Number346374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: