Provider Demographics
NPI:1962517052
Name:KOLKER, HARVEY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:ALAN
Last Name:KOLKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2420
Mailing Address - Country:US
Mailing Address - Phone:631-928-4888
Mailing Address - Fax:631-928-4889
Practice Address - Street 1:111 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2420
Practice Address - Country:US
Practice Address - Phone:631-928-4888
Practice Address - Fax:631-928-4889
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1046252080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00620053Medicaid
B19664Medicare UPIN