Healthcare Provider Details

I. General information

NPI: 1730570748
Provider Name (Legal Business Name): COLLISION REPAIR SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ADAMS ST
LAKEWOOD NJ
08701-2304
US

IV. Provider business mailing address

75 ADAMS ST
LAKEWOOD NJ
08701-2304
US

V. Phone/Fax

Practice location:
  • Phone: 908-330-6826
  • Fax:
Mailing address:
  • Phone: 908-330-6826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: ELIEZER BLECH
Title or Position: PRESIDENT
Credential:
Phone: 908-330-6826