Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 310334 | NY |
NPI | 1821592122 |
---|---|
Provider Name | Dr. Jeffrey David Collins |
First Address | Elmira, NY 14905-1629 |
Second Address | Elmira, NY 14905-1629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2018 |
Last Update Date | 15/11/2021 |