Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 25MA05727300 | NJ |
NPI | 1073680062 |
---|---|
Provider Name | Christopher Kolasa |
First Address | East Brunswick, NJ 08816-5828 |
Second Address | East Brunswick, NJ 08816-5828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6548601 | (05) | NJ |