Provider Demographics
NPI:1073945135
Name:COLLINS, PHILIP (DO)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HURFFVILLE CROSSKEYS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9340
Mailing Address - Country:US
Mailing Address - Phone:856-218-0300
Mailing Address - Fax:856-589-5082
Practice Address - Street 1:405 HURFFVILLE CROSSKEYS RD STE 101
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9340
Practice Address - Country:US
Practice Address - Phone:856-218-0300
Practice Address - Fax:856-589-5082
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09743000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ501331ASDMedicare PIN