Healthcare Provider Details

I. General information

NPI: 1073574869
Provider Name (Legal Business Name): ROBERT EUGENE COLELLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HAMILTON AVE
TRENTON NJ
08629-1915
US

IV. Provider business mailing address

66 W GILBERT ST
TINTON FALLS NJ
07701-4947
US

V. Phone/Fax

Practice location:
  • Phone: 609-599-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB06577200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MB06577200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: