Provider Demographics
NPI:1194555995
Name:KOLESER, MYA ROSE
Entity type:Individual
Prefix:MRS
First Name:MYA
Middle Name:ROSE
Last Name:KOLESER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416-1539
Mailing Address - Country:US
Mailing Address - Phone:973-262-1530
Mailing Address - Fax:
Practice Address - Street 1:178 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416-1539
Practice Address - Country:US
Practice Address - Phone:973-262-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management