Provider Demographics
NPI:1477548550
Name:KOLODIN, ERIC LEWIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LEWIS
Last Name:KOLODIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:35-37 PROGRESS ST
Mailing Address - Street 2:A3
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1179
Mailing Address - Country:US
Mailing Address - Phone:908-458-3928
Mailing Address - Fax:908-668-4845
Practice Address - Street 1:35-37 PROGRESS ST
Practice Address - Street 2:A3
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1179
Practice Address - Country:US
Practice Address - Phone:908-458-3928
Practice Address - Fax:908-668-4845
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00166300213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery