Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 225349 | NY |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 225349 | NY |
NPI | 1225046279 |
---|---|
Provider Name | Alice Kolasa |
First Address | Albany, NY 12212-4890 |
Second Address | Albany, NY 12205-3809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02664551 | (05) | NY |
I19003 | (02) | NY |