Provider Demographics
NPI:1700961992
Name:KOLB, PETER (PA)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:KOLB
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 DEAL RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3508
Mailing Address - Country:US
Mailing Address - Phone:732-804-9222
Mailing Address - Fax:732-531-5507
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-8793
Practice Address - Fax:718-283-8713
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002757-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant