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General NPI Number Information
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NPI Number | 1679805014
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Entity Type | Individual
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Provider Name | DR. ADAM EDWARD COLANDREA
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Gender | Male
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 1128 NY-17K 3
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City | MONTGOMERY
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State | NY
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Zip | 12549
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Country | US
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Telephone | 457-697-4028
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Fax |
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Provider Business Mailing Address
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Address Line | 167 E RIDGE RD
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City | WARWICK
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State | NY
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Zip | 10990-3038
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Country | US
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Telephone | 914-213-4386
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00734700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 011984
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License Number State | NY
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