Healthcare Provider Details

I. General information

NPI: 1780831271
Provider Name (Legal Business Name): KRISTEN COLLERAN M.V.B.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3-21 SADDLE RIVER RD
FAIR LAWN NJ
07410-5620
US

IV. Provider business mailing address

3-21 SADDLE RIVER RD
FAIR LAWN NJ
07410-5620
US

V. Phone/Fax

Practice location:
  • Phone: 201-796-5833
  • Fax:
Mailing address:
  • Phone: 201-796-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number29V100562900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: