Healthcare Provider Details

I. General information

NPI: 1871635664
Provider Name (Legal Business Name): MR. REINALDO COLON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DRUM RD
STATEN ISLAND NY
10305-5001
US

IV. Provider business mailing address

1816 HAMMERSLEY AVE
BRONX NY
10469-3115
US

V. Phone/Fax

Practice location:
  • Phone: 718-354-4414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: