Provider Demographics
NPI:1922078377
Name:COLLINS, HARRY (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ETHEL RD
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2838
Mailing Address - Country:US
Mailing Address - Phone:732-287-2020
Mailing Address - Fax:732-287-2071
Practice Address - Street 1:1 ETHEL RD
Practice Address - Street 2:SUITE 107B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2838
Practice Address - Country:US
Practice Address - Phone:732-287-2020
Practice Address - Fax:732-287-2071
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32839207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2305402Medicaid
NJ1104924455OtherGROUP NPI NUMBER
NJ1104924455OtherGROUP NPI NUMBER
C54001Medicare UPIN