Provider Demographics
NPI:1811519515
Name:COLLINS PODIATRY CORPORATION
Entity type:Organization
Organization Name:COLLINS PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-327-3282
Mailing Address - Street 1:12221 TAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-5372
Mailing Address - Country:US
Mailing Address - Phone:918-327-3282
Mailing Address - Fax:
Practice Address - Street 1:1223 GRANT AVE STE D
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3157
Practice Address - Country:US
Practice Address - Phone:918-327-3282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric