Provider Demographics
NPI:1619536323
Name:COLLEGIATE SPORTS CARE, LLC
Entity Type:Organization
Organization Name:COLLEGIATE SPORTS CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEHRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-200-7370
Mailing Address - Street 1:345 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2339
Mailing Address - Country:US
Mailing Address - Phone:973-200-7370
Mailing Address - Fax:973-822-7905
Practice Address - Street 1:345 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2339
Practice Address - Country:US
Practice Address - Phone:973-200-7370
Practice Address - Fax:973-822-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA06543600OtherNJ LICENSE