Domenico Colletti Jr., PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

25MP00450700 Issued in NJ

Practice address

1930 NJ 35
Wall, NJ 07719

Phone

(732) 456-7777

Fax

(732) 455-1104

NPI assigned

Nov 30, 2017

Last updated

Aug 18, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coyle S Connolly DO PAGroup PAC ID 2961498118, 32 clinicians

NJ Certified Dermatology PCGroup PAC ID 9931492287, 38 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.23 of 100Reported as group

Quality

95.33

Promoting interoperability

86

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coyle S Connolly DO PA

  • Dermatology Physician
  • Linwood, NJ
  • NPI 1053367516
  Medicare reassignment Care Compare group
• NJ Certified Dermatology PC

  • Dermatology Physician
  • Neptune, NJ
  • NPI 1003263807
  Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1851805741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 NJ 35",
            "city": "WALL",
            "state": "NJ",
            "postal_code": "080773534",
            "telephone_number": "732-456-7777",
            "fax_number": "732-455-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 NJ 35",
            "city": "WALL",
            "state": "NJ",
            "postal_code": "07719",
            "telephone_number": "732-456-7777",
            "fax_number": "732-455-1104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLETTI",
        "first_name": "DOMENICO",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-30",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00450700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan A Cavaiola, PHD
• Augusto Caesar Cespedes Jr.
• Tiffany Cherry
• Shobha A Chottera, MD
• Christina Marie Cognetti, MS OTR
• Complete Care by BDM, LLC
• Michael Cosulich, MD
• Crean Counseling LLC
• Crystal Clear Diagnostics Services Inc
• Susan Jane Curley, DDS

• Medical Physician Assistant in Wall, NJ
• Providers in Wall, NJ by specialty
• Medical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.