Provider Demographics
NPI:1316498413
Name:KOLBUSZ, EDYTA (APN)
Entity type:Individual
Prefix:
First Name:EDYTA
Middle Name:
Last Name:KOLBUSZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2562
Mailing Address - Country:US
Mailing Address - Phone:973-595-8400
Mailing Address - Fax:973-595-8501
Practice Address - Street 1:426 UNION BLVD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2562
Practice Address - Country:US
Practice Address - Phone:973-595-8400
Practice Address - Fax:973-595-8501
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00648800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health