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General NPI Number Information
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NPI Number | 1588036040
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Entity Type | Organization
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Legal Business Name | PHYSICIANS COLLABORATIVE AFFILIATES, INC.
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 101 E MILLER ST
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City | ORLANDO
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State | FL
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Zip | 32806-2123
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Country | US
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Telephone | 407-803-4016
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Fax | 407-803-4045
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Provider Business Mailing Address
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Address Line | 501 N ORLANDO AVE SUITE 313, PMB 185
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City | WINTER PARK
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State | FL
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Zip | 32789-7313
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Country | US
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Telephone | 407-803-4016
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Fax | 407-803-4045
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROCCO CONIGLIO
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Credential |
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Telephone | 330-523-0593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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