Healthcare Provider Details

I. General information

NPI: 1275222879
Provider Name (Legal Business Name): COLMACONJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MACCULLOCH AVE
MORRISTOWN NJ
07960-8698
US

IV. Provider business mailing address

7 BISHOP CT
MORRISTOWN NJ
07960-6969
US

V. Phone/Fax

Practice location:
  • Phone: 201-347-2345
  • Fax:
Mailing address:
  • Phone: 907-250-7389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN COUGHLIN
Title or Position: OWNER
Credential: MD
Phone: 201-347-2345