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General NPI Number Information
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NPI Number | 1275356560
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Entity Type | Organization
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Legal Business Name | THE COLLABORATIVE HEALTHCARE GROUP OF NJ
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1598 RTE 130
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-3040
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Country | US
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Telephone | 877-328-7112
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Fax | 877-260-9979
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Provider Business Mailing Address
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Address Line | 5 STONE HILL RD
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-5618
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Country | US
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Telephone | 877-328-7112
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Fax | 877-260-9979
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Authorized Official
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Title or Position | CEO
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Name | KEVIN SCOTT MACNIVEN
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Credential | MBA
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Telephone | 877-328-7112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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