Healthcare Provider Details

I. General information

NPI: 1922078377
Provider Name (Legal Business Name): HARRY COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ETHEL RD SUITE 107B
EDISON NJ
08817-2838
US

IV. Provider business mailing address

1 ETHEL RD SUITE 107B
EDISON NJ
08817-2838
US

V. Phone/Fax

Practice location:
  • Phone: 732-287-2020
  • Fax: 732-287-2071
Mailing address:
  • Phone: 732-287-2020
  • Fax: 732-287-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMA32839
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMA32839
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: