Provider Demographics
NPI:1598739757
Name:KOLPAN, BRETT (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:KOLPAN
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 1:140 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1738 ROUTE 31 NO
Practice Address - Street 2:SUITE 203
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-2014
Practice Address - Country:US
Practice Address - Phone:908-689-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06966100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0090271Medicaid
NJ0090271Medicaid
NJH73801Medicare UPIN
NJ100706QDJMedicare PIN
NJ100706QDJMedicare ID - Type Unspecified