Provider Demographics
NPI:1619012705
Name:IRVING S KOLIN MD PA
Entity Type:Organization
Organization Name:IRVING S KOLIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-644-1122
Mailing Address - Street 1:1065 W. MORSE BLVD, SUITE 202
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3747
Mailing Address - Country:US
Mailing Address - Phone:407-644-1122
Mailing Address - Fax:407-644-6554
Practice Address - Street 1:1065 W. MORSE BLVD, SUITE 202
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3747
Practice Address - Country:US
Practice Address - Phone:407-644-1122
Practice Address - Fax:407-644-6554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00145342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FLD85625Medicare UPIN