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General NPI Number Information
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NPI Number | 1023000353
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Entity Type | Individual
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Provider Name | DAVID C COLLYMORE MD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 1776 CLAY AVE
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City | BRONX
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State | NY
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Zip | 10457-7239
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Country | US
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Telephone | 718-299-1100
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Fax | 718-299-4633
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Provider Business Mailing Address
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Address Line | 1776 CLAY AVE
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City | BRONX
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State | NY
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Zip | 10457-7239
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Country | US
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Telephone | 718-299-1100
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Fax | 718-299-4633
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 225742
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License Number State | NY
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