Provider Demographics
NPI:1770392391
Name:KOLODZEJ, ALEXA
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:KOLODZEJ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-2452
Mailing Address - Country:US
Mailing Address - Phone:973-222-7914
Mailing Address - Fax:
Practice Address - Street 1:174 EDISON RD
Practice Address - Street 2:
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849-2217
Practice Address - Country:US
Practice Address - Phone:973-663-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant