Basic Information
| Provider Information | |||||||||
| NPI: | 1427257187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLESANO | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 MILLPOND LANE | ||||||||
| Address2: | |||||||||
| City: | HOLMES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125314601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458787205 | ||||||||
| FaxNumber: | 8458787205 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 GRASSLANDS RD | ||||||||
| Address2: | |||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937000 | ||||||||
| FaxNumber: | 9144937483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F3320811 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 01918010 | 05 | NY | MEDICAID |