Provider Demographics
NPI:1679805014
Name:COLANDREA, ADAM EDWARD
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:EDWARD
Last Name:COLANDREA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-3038
Mailing Address - Country:US
Mailing Address - Phone:914-213-4386
Mailing Address - Fax:
Practice Address - Street 1:1128 NY-17K
Practice Address - Street 2:3
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549
Practice Address - Country:US
Practice Address - Phone:457-697-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00734700111N00000X
NY011984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor