Healthcare Provider Details

I. General information

NPI: 1992957922
Provider Name (Legal Business Name): COLIN LEANDER FAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 COLUMBIA TPKE
FLORHAM PARK NJ
07932-2106
US

IV. Provider business mailing address

124 COLUMBIA TPKE
FLORHAM PARK NJ
07932-2106
US

V. Phone/Fax

Practice location:
  • Phone: 973-822-3000
  • Fax: 973-822-1726
Mailing address:
  • Phone: 973-822-3000
  • Fax: 973-822-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25MA08496900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: