Healthcare Provider Details

I. General information

NPI: 1720949373
Provider Name (Legal Business Name): COLETTE BAUMBUSCH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BETTS TRL
BRIDGEWATER NJ
08807-5589
US

IV. Provider business mailing address

5 BETTS TRL
BRIDGEWATER NJ
08807-5589
US

V. Phone/Fax

Practice location:
  • Phone: 908-642-2467
  • Fax:
Mailing address:
  • Phone: 908-642-2467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22HI00551100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: