Provider Demographics
NPI:1164022877
Name:KOLOTINSKY, MICHAEL (ND)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KOLOTINSKY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SANDUSKY RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6917
Mailing Address - Country:US
Mailing Address - Phone:845-664-0929
Mailing Address - Fax:
Practice Address - Street 1:33 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1637
Practice Address - Country:US
Practice Address - Phone:203-270-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
CT671175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist