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General NPI Number Information
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NPI Number | 1356317796
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Entity Type | Individual
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Provider Name | GIGETTE COLLAZO HARFST O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/26/2006
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 15 W WASHINGTON AVE
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City | WASHINGTON
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State | NJ
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Zip | 07882-1916
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Country | US
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Telephone | 908-689-0240
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Fax | 908-689-0676
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Provider Business Mailing Address
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Address Line | 15 W WASHINGTON AVE
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City | WASHINGTON
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State | NJ
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Zip | 07882-1916
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Country | US
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Telephone | 908-689-0240
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Fax | 908-689-0676
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00514000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0601002125
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618000536
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OM00091000
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License Number State | NJ
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