Active NPI
Colin Jack Willoughby
- Student in an Organized Health Care Education/Training Program
- New York, NY
National Provider Identifier
1508775701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 177 Fort Washington Ave
New York, NY 10032-3733 - Phone
- (212) 305-2500
- NPI assigned
- Sep 3, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NY | Primary |
Addresses
Primary practice location
177 Fort Washington Ave
New York, NY 10032-3733
Mailing address
60 Haven Avenue
Cjw2201
New York, NY 10032
Phone (805) 490-6074
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788393600000",
"number": "1508775701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 HAVEN AVENUE",
"address_2": "CJW2201",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10032",
"telephone_number": "805-490-6074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "177 FORT WASHINGTON AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323733",
"telephone_number": "212-305-2500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLOUGHBY",
"first_name": "COLIN",
"middle_name": "JACK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-09-03",
"last_updated": "2026-09-03",
"certification_date": "2026-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NY",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.