Provider Demographics
NPI:1962552646
Name:COLLETTE-ZACHAR, LYNN (NP)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:COLLETTE-ZACHAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 BAY RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1425
Mailing Address - Country:US
Mailing Address - Phone:518-793-2483
Mailing Address - Fax:518-793-2485
Practice Address - Street 1:536 BAY RD
Practice Address - Street 2:SUITE1
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1425
Practice Address - Country:US
Practice Address - Phone:518-793-2483
Practice Address - Fax:518-793-2485
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3347581363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0663Medicare PIN