Provider Demographics
NPI:1851357297
Name:COLASANTI, KIMBERLY A (PA -C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:COLASANTI
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:A
Other - Last Name:MEADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA- C
Mailing Address - Street 1:80 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5727
Mailing Address - Country:US
Mailing Address - Phone:732-741-2313
Mailing Address - Fax:732-741-1952
Practice Address - Street 1:80 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5727
Practice Address - Country:US
Practice Address - Phone:732-741-2313
Practice Address - Fax:732-741-1952
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00196600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P19304Medicare UPIN
NJ123180BW0Medicare PIN