Provider Demographics
NPI:1043080955
Name:COLLINS, KEVIN P
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TANIA CT
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1245
Mailing Address - Country:US
Mailing Address - Phone:908-797-9388
Mailing Address - Fax:
Practice Address - Street 1:3 TANIA CT
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1245
Practice Address - Country:US
Practice Address - Phone:908-797-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care