Individual
COLLEEN MARY TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. ED
Contact information
Practice address
90 HENRY ST, INWOOD, NY 11096-2335
(516) 239-2182
(516) 374-1068
Mailing address
38 COMMONWEALTH AVE, LAKE GROVE, NY 11755-1723
(516) 946-3136
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
1074492
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M000000X
—
NY
Enumeration date
07/18/2012
Last updated
07/18/2012
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