Provider Demographics
NPI:1588683528
Name:KOLKER, ADAM R (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:R
Last Name:KOLKER
Suffix:
Gender:M
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:PO BOX 2462
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0058
Mailing Address - Country:US
Mailing Address - Phone:212-744-6500
Mailing Address - Fax:212-355-9231
Practice Address - Street 1:655 PARK AVE
Practice Address - Street 2:SUITE NEC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5937
Practice Address - Country:US
Practice Address - Phone:212-744-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1885461208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH16069Medicare UPIN
NY41L521Medicare ID - Type Unspecified