Provider Demographics
NPI:1972058931
Name:KOLBY, ELIZABETH ANNE (R,D,)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:KOLBY
Suffix:
Gender:F
Credentials:R,D,
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:8207 MAIN ST
Mailing Address - Street 2:SUITES 7 & 8
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6060
Mailing Address - Country:US
Mailing Address - Phone:716-626-4200
Mailing Address - Fax:716-626-4201
Practice Address - Street 1:8207 MAIN ST
Practice Address - Street 2:SUITES 7 & 8
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6060
Practice Address - Country:US
Practice Address - Phone:716-626-4200
Practice Address - Fax:716-626-4201
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003475-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered