Provider Demographics
NPI:1841838471
Name:KOLOTSI NP FAMILY HEALTH PC
Entity type:Organization
Organization Name:KOLOTSI NP FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LENYK KOLOTSI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-494-2204
Mailing Address - Street 1:2952 BRIGHTON 3RD ST # STSTE201
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7077
Mailing Address - Country:US
Mailing Address - Phone:718-747-4777
Mailing Address - Fax:718-975-4337
Practice Address - Street 1:3130 BRIGHTON 6TH ST STE 1D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6970
Practice Address - Country:US
Practice Address - Phone:718-747-4777
Practice Address - Fax:718-975-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF340451OtherLICENSE