Healthcare Provider Details

I. General information

NPI: 1164258117
Provider Name (Legal Business Name): COLONIA PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAINT GEORGES AVE STE G
AVENEL NJ
07001-1000
US

IV. Provider business mailing address

1500 SAINT GEORGES AVE STE G
AVENEL NJ
07001-1000
US

V. Phone/Fax

Practice location:
  • Phone: 732-382-8111
  • Fax:
Mailing address:
  • Phone: 732-382-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: NIMISHA PATEL
Title or Position: ADMIN
Credential:
Phone: 732-710-6412