Provider Demographics
NPI:1841293024
Name:COLL, ELIZABETH (NP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:COLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 BEECH RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1501
Mailing Address - Country:US
Mailing Address - Phone:201-689-7357
Mailing Address - Fax:973-778-6676
Practice Address - Street 1:905 ALLWOOD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1945
Practice Address - Country:US
Practice Address - Phone:973-778-6676
Practice Address - Fax:973-778-2666
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10619800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS99384Medicare UPIN