Healthcare Provider Details

I. General information

NPI: 1609741867
Provider Name (Legal Business Name): MS. COLETTE OPAL ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CENTRAL AVE FL 3
EAST ORANGE NJ
07018-1951
US

IV. Provider business mailing address

564 SINCLAIR TER
SOUTH ORANGE NJ
07079-2624
US

V. Phone/Fax

Practice location:
  • Phone: 973-561-4212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26MJ15064200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: