Provider Demographics
NPI:1194386318
Name:COLON, SOLIMAR VICTORIA (PA)
Entity Type:Individual
Prefix:MS
First Name:SOLIMAR
Middle Name:VICTORIA
Last Name:COLON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 KIPP AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1122
Mailing Address - Country:US
Mailing Address - Phone:201-674-2418
Mailing Address - Fax:
Practice Address - Street 1:31-00 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3963
Practice Address - Country:US
Practice Address - Phone:201-796-2255
Practice Address - Fax:201-796-3711
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00528700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant