Provider Demographics
NPI:1679189187
Name:KOLESA, PATRICIA HELEN (MS, RD, RDN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HELEN
Last Name:KOLESA
Suffix:
Gender:F
Credentials:MS, RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1206
Mailing Address - Country:US
Mailing Address - Phone:732-770-3205
Mailing Address - Fax:
Practice Address - Street 1:240 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1206
Practice Address - Country:US
Practice Address - Phone:732-388-2782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86149913133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered