MEDICARE: DR. MICHAEL JOSEPH COLLURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	0460351	NY

General Provider Information

NPI Number	:	1447249297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSEPH COLLURA

Provider Business Mailing Address
First Line	:	57 W 57TH ST
Second Line	:	SUITE 1207
City	:	NEW YORK
State	:	NY
Zip	:	10019-2802
Country	:	US
Telephone Number	:	212-980-7857
Fax Number	:	212-980-7887

Provider Business Practice Location Address
First Line	:	57 W 57TH ST
Second Line	:	SUITE 1207
City	:	NEW YORK
State	:	NY
Zip	:	10019-2802
Country	:	US
Telephone Number	:	212-980-7857
Fax Number	:	212-980-7887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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