Provider Demographics
NPI:1649421140
Name:CHRIS F COLOPINTO DO LLC
Entity type:Organization
Organization Name:CHRIS F COLOPINTO DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:COLOPINTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-906-3902
Mailing Address - Street 1:1168 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-2802
Mailing Address - Country:US
Mailing Address - Phone:856-365-3286
Mailing Address - Fax:
Practice Address - Street 1:1168 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-2802
Practice Address - Country:US
Practice Address - Phone:856-365-3286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03632300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3448801Medicaid
NJ3448801Medicaid