Healthcare Provider Details

I. General information

NPI: 1952390536
Provider Name (Legal Business Name): JOHN A COLLINI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 ROUTE 9
MANALAPAN NJ
07726-3284
US

IV. Provider business mailing address

357 ROUTE 9
MANALAPAN NJ
07726-3284
US

V. Phone/Fax

Practice location:
  • Phone: 732-972-2221
  • Fax: 732-972-1195
Mailing address:
  • Phone: 732-972-2221
  • Fax: 732-972-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5021
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: