Healthcare Provider Details

I. General information

NPI: 1225337587
Provider Name (Legal Business Name): LUIS COLLAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 ROUTE 17 SUITE 207
TUXEDO PARK NY
10987-4406
US

IV. Provider business mailing address

233 ROUTE 17 SUITE 207
TUXEDO PARK NY
10987-4406
US

V. Phone/Fax

Practice location:
  • Phone: 845-915-3061
  • Fax:
Mailing address:
  • Phone: 845-915-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number308283
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: