Organization
MYLENE COLUCCI MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYLENE COLUCCI MD (PRESIDENT)
(516) 676-2878
Entity
Organization
Contact information
Practice address
3 SCHOOL ST, SUITE 303, GLEN COVE, NY 11542-2590
(516) 676-2878
(516) 674-2256
Mailing address
3 SCHOOL ST, SUITE 303, GLEN COVE, NY 11542-2590
(516) 676-2878
(516) 674-2256
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
226904
NY
207RP1001X
Pulmonary Disease Physician
Primary
226904
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
226904
LICENSE
NY
Enumeration date
02/22/2012
Last updated
02/22/2012
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