Basic Information
| Provider Information | |||||||||
| NPI: | 1891782777 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLBY | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5450 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100875450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187805246 | ||||||||
| FaxNumber: | 7187803259 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 6TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112153609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187805246 | ||||||||
| FaxNumber: | 7187803259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 12/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | ME0076743 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 157414 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 00869796 | 05 | NY | MEDICAID | 256292800 | 05 | FL | MEDICAID | 44870 | 01 | FL | BC FLORIDA | OTHER |