Provider Demographics
NPI:1538253109
Name:COLAGRECO, JOSEPH PATRICK (NP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:COLAGRECO
Suffix:
Gender:M
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:PO BOX 231385
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-0024
Mailing Address - Country:US
Mailing Address - Phone:917-821-1763
Mailing Address - Fax:
Practice Address - Street 1:1230 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6307
Practice Address - Country:US
Practice Address - Phone:917-821-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267499363LA2200X
NY300649363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health