Basic Information
| Provider Information | |||||||||
| NPI: | 1891355137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLB | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 ROUTE 17 NORTH | ||||||||
| Address2: | #255 | ||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014904333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 PALMER AVE | ||||||||
| Address2: | |||||||||
| City: | BRONXVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107083403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147871000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2019 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.