Provider Demographics
NPI:1518399088
Name:COLONIAL HEALTH INC
Entity type:Organization
Organization Name:COLONIAL HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-900-0375
Mailing Address - Street 1:3501 ROUTE 42
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1734
Mailing Address - Country:US
Mailing Address - Phone:215-900-0375
Mailing Address - Fax:
Practice Address - Street 1:3501 ROUTE 42
Practice Address - Street 2:SUITE 130
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1734
Practice Address - Country:US
Practice Address - Phone:215-900-0375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center