Provider Demographics
NPI:1992957922
Name:FAILEY, COLIN LEANDER (MD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:LEANDER
Last Name:FAILEY
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 1:124 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2106
Mailing Address - Country:US
Mailing Address - Phone:973-822-3000
Mailing Address - Fax:973-822-1726
Practice Address - Street 1:124 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2106
Practice Address - Country:US
Practice Address - Phone:973-822-3000
Practice Address - Fax:973-822-1726
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA084969002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ243029CEJMedicare PIN