Provider Demographics
NPI:1154575330
Name:KOLESAR, ADAM J (MSP,CCC-SLP, BRS-S)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:J
Last Name:KOLESAR
Suffix:
Gender:M
Credentials:MSP,CCC-SLP, BRS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 216TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2810
Mailing Address - Country:US
Mailing Address - Phone:718-281-8884
Mailing Address - Fax:
Practice Address - Street 1:2901 216TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2810
Practice Address - Country:US
Practice Address - Phone:718-281-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007180-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist