Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 25MD00289900 | NJ |
NPI | 1174726236 |
---|---|
Provider Name | Gerard A Collins |
First Address | Marlton, NJ 08053-4197 |
Second Address | Maple Shade, NJ 08052-2411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0222127 | (05) | NJ |