Individual
BERNARD COLCLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
13056 230TH ST, LAURELTON, NY 11413-1828
(516) 592-9657
Mailing address
13056 230TH ST, LAURELTON, NY 11413-1828
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
249421
NY
Other
Enumeration date
11/09/2013
Last updated
11/09/2013
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