Provider Demographics
NPI:1093167272
Name:KALBACH, COTY (PA-C)
Entity type:Individual
Prefix:
First Name:COTY
Middle Name:
Last Name:KALBACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 ELLIS DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-3410
Mailing Address - Country:US
Mailing Address - Phone:484-332-0421
Mailing Address - Fax:
Practice Address - Street 1:1141 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08051-1608
Practice Address - Country:US
Practice Address - Phone:732-456-7777
Practice Address - Fax:732-200-1056
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00927900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical