Provider Demographics
NPI:1306096318
Name:EILEEN F COLLIGAN, MD, PC
Entity type:Organization
Organization Name:EILEEN F COLLIGAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:COLLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-982-5633
Mailing Address - Street 1:60 E 9TH ST
Mailing Address - Street 2:SUITE 134
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6403
Mailing Address - Country:US
Mailing Address - Phone:212-982-5633
Mailing Address - Fax:212-982-5690
Practice Address - Street 1:60 E 9TH ST
Practice Address - Street 2:SUITE 134
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6403
Practice Address - Country:US
Practice Address - Phone:212-982-5633
Practice Address - Fax:212-982-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125788207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972599645OtherINDIVIDUAL NPI #
NY125788OtherMEDICAL LICENSE
NY00399284Medicaid
SERIAL#001120OtherUSCG-CERTIFICATE OF REGISTRY-MEDICAL DOCTOR
NY10507901OtherCAQH
NJ25MA04143100OtherMEDICAL LICENSE
NJ25MA04143100OtherMEDICAL LICENSE
08A971Medicare PIN
NJ25MA04143100OtherMEDICAL LICENSE