Provider Demographics
NPI:1730669243
Name:KOLPON, SIARA NICOLE (PHYSICIAN ASSITANT)
Entity Type:Individual
Prefix:
First Name:SIARA
Middle Name:NICOLE
Last Name:KOLPON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSITANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:630 BROAD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1169
Mailing Address - Country:US
Mailing Address - Phone:201-500-9450
Mailing Address - Fax:201-500-9451
Practice Address - Street 1:630 BROAD ST STE 3-300
Practice Address - Street 2:
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1169
Practice Address - Country:US
Practice Address - Phone:201-500-9450
Practice Address - Fax:201-500-9451
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical