Healthcare Provider Details

I. General information

NPI: 1093194904
Provider Name (Legal Business Name): COLLEEN LITTLE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 US HIGHWAY 22
BRIDGEWATER NJ
08807-2943
US

IV. Provider business mailing address

1200 US HIGHWAY 22
BRIDGEWATER NJ
08807-2943
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-6113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB10911400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: