Provider Demographics
NPI:1629088687
Name:KOLBASOVSKY, ANDREW (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:KOLBASOVSKY
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BARNEGAT DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857
Mailing Address - Country:US
Mailing Address - Phone:732-605-9469
Mailing Address - Fax:
Practice Address - Street 1:55 WATER STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10041
Practice Address - Country:US
Practice Address - Phone:646-447-7231
Practice Address - Fax:646-447-3234
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015327-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical