Provider Demographics
NPI:1043259666
Name:KOLKER, MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:KOLKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HOPEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1376
Mailing Address - Country:US
Mailing Address - Phone:914-837-5088
Mailing Address - Fax:
Practice Address - Street 1:4 CROTTY LN
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4778
Practice Address - Country:US
Practice Address - Phone:845-562-0760
Practice Address - Fax:845-562-1019
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231752207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7M4611Medicare ID - Type Unspecified
NYH47039Medicare UPIN