Healthcare Provider Details

I. General information

NPI: 1558606954
Provider Name (Legal Business Name): COLLEEN SNYDER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 06/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 POMPTON AVE
VERONA NJ
07044-2917
US

IV. Provider business mailing address

50 POMPTON AVE
VERONA NJ
07044-2917
US

V. Phone/Fax

Practice location:
  • Phone: 973-857-3400
  • Fax:
Mailing address:
  • Phone: 973-857-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00306000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number015842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: