Provider Demographics
NPI:1962767947
Name:COLLINS, MARIE VOGENIE
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:VOGENIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTRAL PARK W
Mailing Address - Street 2:17B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5880
Mailing Address - Country:US
Mailing Address - Phone:212-865-1614
Mailing Address - Fax:
Practice Address - Street 1:400 CENTRAL PARK W
Practice Address - Street 2:17B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5880
Practice Address - Country:US
Practice Address - Phone:212-865-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1809653222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist