Provider Demographics
NPI:1750537213
Name:KOLEFF, STEPHAN NICHOLAS SR (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:NICHOLAS
Last Name:KOLEFF
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1127
Mailing Address - Country:US
Mailing Address - Phone:201-507-5758
Mailing Address - Fax:201-507-5827
Practice Address - Street 1:310 4TH ST
Practice Address - Street 2:
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1127
Practice Address - Country:US
Practice Address - Phone:201-507-5758
Practice Address - Fax:201-507-5827
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ541546Medicare PIN