Healthcare Provider Details

I. General information

NPI: 1982974358
Provider Name (Legal Business Name): EXTEND CARE FAMILY HEALTH NP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HERKIMER RD
UTICA NY
13502
US

IV. Provider business mailing address

101 HERKIMER RD
UTICA NY
13502-2311
US

V. Phone/Fax

Practice location:
  • Phone: 315-724-6144
  • Fax: 315-724-3978
Mailing address:
  • Phone: 315-724-6144
  • Fax: 315-724-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335944
License Number StateNY

VIII. Authorized Official

Name: JONATHAN DANIEL COLINO
Title or Position: OWNER
Credential: DNP
Phone: 315-724-6144