Healthcare Provider Details

I. General information

NPI: 1225020324
Provider Name (Legal Business Name): MANUEL COLUMBRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S BROADWAY SAINT JOSEPH'S MEDICAL CENTER
YONKERS NY
10701-4006
US

IV. Provider business mailing address

100 ROUTE 59 SUITE 105
SUFFERN NY
10901-4927
US

V. Phone/Fax

Practice location:
  • Phone: 914-378-7000
  • Fax: 845-357-5777
Mailing address:
  • Phone: 845-357-5775
  • Fax: 845-357-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number128951-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: