Basic Information
| Provider Information | |||||||||
| NPI: | 1376577684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLANO | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755982 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755982 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 175979 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 7627195 | 01 | NY | AETNA PROV# | OTHER | G0189393590 | 01 | NY | BLUE CHOICE GROUP | OTHER | 000912254001 | 01 | NY | BS WNY/HEALTHNOW # | OTHER | 00040236001 | 01 | NY | UNIVERA PROV# | OTHER | 2222 | 01 | NY | BLUE SHIELD GROUP | OTHER | MDA542 | 01 | NY | PREFERRED CARE | OTHER | 01239312 | 05 | NY | MEDICAID |