Provider Demographics
NPI:1356700033
Name:KOLB, SUSAN GAIL
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GAIL
Last Name:KOLB
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 1:3 FOX RUN
Mailing Address - Street 2:LIFE WITH JOY INC
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-2000
Mailing Address - Country:US
Mailing Address - Phone:201-341-0436
Mailing Address - Fax:
Practice Address - Street 1:3 FOX RUN
Practice Address - Street 2:3 FOX RUN
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-2000
Practice Address - Country:US
Practice Address - Phone:201-341-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46-4109113OtherEIN