Provider Demographics
NPI:1538254974
Name:KOLBER, BRYAN R (DPM)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:R
Last Name:KOLBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 N PUTT CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3405
Mailing Address - Country:US
Mailing Address - Phone:845-255-4414
Mailing Address - Fax:845-255-8415
Practice Address - Street 1:66 N PUTT CORNERS RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-3405
Practice Address - Country:US
Practice Address - Phone:845-255-4414
Practice Address - Fax:845-255-8415
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003509213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00826128Medicaid
NYP39371Medicare PIN
NYT51204Medicare UPIN
NY00826128Medicaid