Provider Demographics
NPI:1689216558
Name:COLIN ARCHER THERESA ARCHER ENTERPRISES LLC
Entity Type:Organization
Organization Name:COLIN ARCHER THERESA ARCHER ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:609-751-6625
Mailing Address - Street 1:108 STRAUBE CENTER BLVD STE I-17
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1448
Mailing Address - Country:US
Mailing Address - Phone:609-751-6625
Mailing Address - Fax:
Practice Address - Street 1:108 STRAUBE CENTER BLVD STE I-17
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1448
Practice Address - Country:US
Practice Address - Phone:609-751-6625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty