Provider Demographics
NPI:1306148226
Name:CHRISTOPHER KOLASA MD PA
Entity type:Organization
Organization Name:CHRISTOPHER KOLASA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-254-4200
Mailing Address - Street 1:6 AUER CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5828
Mailing Address - Country:US
Mailing Address - Phone:732-254-4200
Mailing Address - Fax:732-254-4256
Practice Address - Street 1:6 AUER CT
Practice Address - Street 2:SUITE C
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5828
Practice Address - Country:US
Practice Address - Phone:732-254-4200
Practice Address - Fax:732-254-4256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05727300207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6548601Medicaid
NJ624883Medicare PIN
NJ6548601Medicaid