Provider Demographics
NPI:1154361897
Name:KOLARSICK, MARIA (DNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KOLARSICK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 RIVERLAWN DR
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3319
Mailing Address - Country:US
Mailing Address - Phone:732-842-9167
Mailing Address - Fax:
Practice Address - Street 1:43 N GILBERT ST STE 2
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4914
Practice Address - Country:US
Practice Address - Phone:732-747-3376
Practice Address - Fax:732-774-8083
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO06557200363LC1500X
NJ1524644207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP68046Medicare UPIN
NJ062660Medicare PIN