Provider Demographics
NPI:1902009459
Name:KOLESSA, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KOLESSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 HILLCREST RD
Mailing Address - Street 2:# A24
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1520
Mailing Address - Country:US
Mailing Address - Phone:732-425-3564
Mailing Address - Fax:
Practice Address - Street 1:44 MONROE ST
Practice Address - Street 2:# A24
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7701
Practice Address - Country:US
Practice Address - Phone:732-425-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434982207RG0300X
NY254294-1207RG0300X
NJ25MA08471100207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine