Healthcare Provider Details

I. General information

NPI: 1134183007
Provider Name (Legal Business Name): EDWARD MICHAEL COLLOPY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SPEEDWELL AVE SUITE 108
MORRIS PLAINS NJ
07950-2132
US

IV. Provider business mailing address

520 SPEEDWELL AVE SUITE 108
MORRIS PLAINS NJ
07950-2132
US

V. Phone/Fax

Practice location:
  • Phone: 973-984-9100
  • Fax: 973-984-9181
Mailing address:
  • Phone: 973-984-9100
  • Fax: 973-984-9181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA06301500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: