Provider Demographics
NPI:1205079555
Name:COLLMAN, ERROL ADE (LMT LAC)
Entity type:Individual
Prefix:
First Name:ERROL
Middle Name:ADE
Last Name:COLLMAN
Suffix:
Gender:M
Credentials:LMT LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9806 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1837
Mailing Address - Country:US
Mailing Address - Phone:718-755-2369
Mailing Address - Fax:
Practice Address - Street 1:430 79TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3708
Practice Address - Country:US
Practice Address - Phone:718-748-6644
Practice Address - Fax:718-748-6851
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003271171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist