Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25MA08206100 | NJ |
N | 208600000X | Surgeon | 25MA08206100 | NJ |
Y | 2086S0129X | Vascular Surgeon | 25MA08206100 | NJ |
NPI | 1003971102 |
---|---|
Provider Name | Stephen Kolakowski JR. |
First Address | West Long Branch, NJ 07764-1177 |
Second Address | West Long Branch, NJ 07764-1177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 16/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0133141 | (05) | NJ |