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General NPI Number Information
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NPI Number | 1811519515
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Entity Type | Organization
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Legal Business Name | COLLINS PODIATRY CORPORATION
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 1223 GRANT AVE STE D
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City | NOVATO
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State | CA
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Zip | 94945-3157
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Country | US
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Telephone | 918-327-3282
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Fax |
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Provider Business Mailing Address
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Address Line | 12221 TAYLOR CT
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City | WEST WINDSOR
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State | NJ
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Zip | 08550-5372
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Country | US
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Telephone | 918-327-3282
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADAM COLLINS
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Credential | DPM
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Telephone | 918-327-3282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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