Provider Demographics
NPI:1861007981
Name:KOLOGE, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:KOLOGE
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 1:32 NEW ST APT C
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1659
Mailing Address - Country:US
Mailing Address - Phone:848-444-2149
Mailing Address - Fax:
Practice Address - Street 1:32 NEW ST APT C
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1659
Practice Address - Country:US
Practice Address - Phone:848-444-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01370900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist