Provider Demographics
NPI:1144475872
Name:EASY, COLEEN ROSEMARIE (NP)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:ROSEMARIE
Last Name:EASY
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 1:17 PHYLLIS DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2630
Mailing Address - Country:US
Mailing Address - Phone:845-517-4737
Mailing Address - Fax:
Practice Address - Street 1:17 PHYLLIS DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2630
Practice Address - Country:US
Practice Address - Phone:845-271-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340383-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care