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General NPI Number Information
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NPI Number | 1275222879
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Entity Type | Organization
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Legal Business Name | COLMACONJ, LLC
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 7 MACCULLOCH AVE
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City | MORRISTOWN
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State | NJ
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Zip | 07960-8698
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Country | US
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Telephone | 201-347-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 7 BISHOP CT
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6969
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Country | US
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Telephone | 907-250-7389
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLLEEN COUGHLIN
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Credential | MD
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Telephone | 201-347-2345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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