Provider Demographics
NPI:1538490925
Name:KOLBE, JASON JAY (LAC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JAY
Last Name:KOLBE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:220 FORT SALONGA RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3900
Mailing Address - Country:US
Mailing Address - Phone:516-669-1243
Mailing Address - Fax:631-754-2909
Practice Address - Street 1:220 FORT SALONGA RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3900
Practice Address - Country:US
Practice Address - Phone:516-669-1243
Practice Address - Fax:631-754-2909
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002576171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist