Healthcare Provider Details

I. General information

NPI: 1356671887
Provider Name (Legal Business Name): COLIN RUSSELL O'REILLY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOMERSET ST
NEW BRUNSWICK NJ
08901-1942
US

IV. Provider business mailing address

200 SOMERSET ST
NEW BRUNSWICK NJ
08901-1942
US

V. Phone/Fax

Practice location:
  • Phone: 732-258-7000
  • Fax:
Mailing address:
  • Phone: 732-258-7000
  • Fax: 908-389-5675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MB08636600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: