Individual
MRS. COLLEEN MARY DEFALCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
VA MEDICAL CENTER, DEPT OF GASTROENTEROLOGY, 79 MIDDLEVILLE ROAD, NORTHPORT, NY 11768-2290
(631) 261-4400
(631) 486-6113
Mailing address
17 COLONIAL DR, SMITHTOWN, NY 11787-4212
(631) 864-7279
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F300698-1
NY
Other
Enumeration date
07/02/2007
Last updated
07/02/2019
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