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Individual

DR. COLIN A, PEMBERTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
500 ORANGE ST, SUITE 1, NEWARK, NJ 07107-2944
(973) 842-8398
Mailing address
2 DEVONSHIRE TER, WEST ORANGE, NJ 07052-2708
(973) 444-0983

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
025MA08530400
NJ
261QP2300X
Primary Care Clinic/Center
025MA08530400
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0198323
NJ
Enumeration date
02/20/2009
Last updated
03/18/2015
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