Provider Demographics
NPI:1114368610
Name:KOLAJ, BRUNILDA (MD)
Entity Type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:
Last Name:KOLAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:315-594-9444
Mailing Address - Fax:315-594-9276
Practice Address - Street 1:6254 LAWVILLE RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-9792
Practice Address - Country:US
Practice Address - Phone:315-594-9444
Practice Address - Fax:315-594-9276
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY286472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program