Provider Demographics
NPI:1760024665
Name:KOLODYNSKI, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:KOLODYNSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WATERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3147
Mailing Address - Country:US
Mailing Address - Phone:347-208-9966
Mailing Address - Fax:
Practice Address - Street 1:355 US ROUTE 22
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07081
Practice Address - Country:US
Practice Address - Phone:973-467-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00545700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical