Provider Demographics
NPI:1306257100
Name:BEEGLE, COLLEEN MARIE
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:BEEGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:DE LA MONTAIGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:ROOM M513
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-3259
Mailing Address - Fax:212-717-1574
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:ROOM M513
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-3259
Practice Address - Fax:212-717-1574
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily