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General NPI Number Information
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NPI Number | 1518326339
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Entity Type | Organization
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Legal Business Name | COLIBRY LLC
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 2196 JUNEBERRY CT
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City | WARRINGTON
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State | PA
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Zip | 18976-1970
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Country | US
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Telephone | 215-687-0898
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1666
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City | DOYLESTOWN
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State | PA
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Zip | 18901-0259
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Country | US
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Telephone | 215-687-0898
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Fax | 215-343-5686
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. OLEG NIKISHIN
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Credential | ND
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Telephone | 215-687-0898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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