Provider Demographics
NPI:1013681220
Name:ALEXANDER KOLESSA MEDICAL P.C.
Entity Type:Organization
Organization Name:ALEXANDER KOLESSA MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLESSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-425-3564
Mailing Address - Street 1:465 HILLCREST RD
Mailing Address - Street 2:
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:866-633-3687
Practice Address - Street 1:44 MONROE ST # A24
Practice Address - Street 2:
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:866-633-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health