MEDICARE: HARRY COLLINS, MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	MA32839	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1922078377	OTHER		NPI INDIVIDUAL NUMBER

General Provider Information

NPI Number	:	1104924455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRY COLLINS, MD LLC

Provider Business Mailing Address
First Line	:	1 ETHEL RD
Second Line	:	SUITE 107B
City	:	EDISON
State	:	NJ
Zip	:	08817-2838
Country	:	US
Telephone Number	:	732-287-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ETHEL RD
Second Line	:	SUITE 107B
City	:	EDISON
State	:	NJ
Zip	:	08817-2838
Country	:	US
Telephone Number	:	732-287-2020
Fax Number	:	732-287-2071

Authorized Official
Title or Position	:	OWNER
Name	:	HARRY COLLINS
Credential	:	MD
Telephone Number	:	732-287-2020

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/29/2011

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