Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 1524644 | NJ |
N | 363LC1500X | Nurse Practitioner - Community Health | 26NO06557200 | NJ |
NPI | 1154361897 |
---|---|
Provider Name | Maria Kolarsick |
First Address | Fair Haven, NJ 07704-3319 |
Second Address | Tinton Falls, NJ 07701-4914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 30/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P68046 | (02) | NJ |