Healthcare Provider Details

I. General information

NPI: 1598739757
Provider Name (Legal Business Name): BRETT KOLPAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 ROUTE 31 NO SUITE 203
FLEMINGTON NJ
08809-2014
US

IV. Provider business mailing address

140 BOULEVARD
WASHINGTON NJ
07882-1761
US

V. Phone/Fax

Practice location:
  • Phone: 908-689-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06966100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: