Provider Demographics
NPI:1285890285
Name:COLLELUORI, KRISTINE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:COLLELUORI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E CARVER ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3409
Mailing Address - Country:US
Mailing Address - Phone:631-424-1887
Mailing Address - Fax:631-760-2000
Practice Address - Street 1:25 E CARVER ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3409
Practice Address - Country:US
Practice Address - Phone:631-424-1887
Practice Address - Fax:631-760-2000
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007666-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant