Doctor Name: | MR. THOMAS COLGAN |
NPI Number: | 1104256007 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 1211790 |
Business Practice Address: | 140 Lester Drive Tappan, NY - 10983 |
Business Phone Number: | 8456801300 |
Business Fax Number: | |
Mailing Address: | 160 Van Wyck Rd., BLAUVELT |
State: | NY |
Postal Code: | 10913 |
Phone Number: | 8456801000 |
Fax Number: | |
NPI Enumeration Date: | 11/14/2013 |
NPI Last Update Date: | 11/14/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 1211790 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |