Healthcare Provider Details

I. General information

NPI: 1609221688
Provider Name (Legal Business Name): JESSICA COLLINS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 PRINCETON PIKE BLDG 4A
LAWRENCEVILLE NJ
08648-2201
US

IV. Provider business mailing address

379 CAMPUS DR STE 3
SOMERSET NJ
08873-1161
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-1700
  • Fax: 732-463-5532
Mailing address:
  • Phone: 732-937-8939
  • Fax: 732-418-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00351300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: