Provider Demographics
NPI:1265906002
Name:KOLB, MERRYL NEW (APN)
Entity type:Individual
Prefix:
First Name:MERRYL
Middle Name:NEW
Last Name:KOLB
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-5708
Mailing Address - Country:US
Mailing Address - Phone:732-531-8200
Mailing Address - Fax:732-531-8201
Practice Address - Street 1:1025 ROUTE 35
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4079
Practice Address - Country:US
Practice Address - Phone:732-531-8200
Practice Address - Fax:732-531-8201
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00897200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine