Provider Demographics
NPI:1902991086
Name:COLLINS, CHRISTOPHER DENNIS (MS, PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DENNIS
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:193 GLEN SUMMER RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-5027
Mailing Address - Country:US
Mailing Address - Phone:631-472-0281
Mailing Address - Fax:
Practice Address - Street 1:6 TECHNOLOGY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4047
Practice Address - Country:US
Practice Address - Phone:631-689-6698
Practice Address - Fax:631-751-5548
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004429363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYZ8797X0281Medicare PIN
NYS52940Medicare UPIN