MEDICARE: KOLB RADIOLOGY P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1639542939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOLB RADIOLOGY P.C.

Provider Business Mailing Address
First Line	:	307 E 60TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-1505
Country	:	US
Telephone Number	:	212-602-1900
Fax Number	:	646-666-0669

Provider Business Practice Location Address
First Line	:	307 E 60TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-1505
Country	:	US
Telephone Number	:	212-602-1900
Fax Number	:	646-666-0669

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS KOLB
Credential	:
Telephone Number	:	212-602-1900

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	11/09/2015

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