Healthcare Provider Details

I. General information

NPI: 1144647587
Provider Name (Legal Business Name): NADEEM KOLIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 629
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

3 COOPER PLZ STE 404
CAMDEN NJ
08103
US

V. Phone/Fax

Practice location:
  • Phone: 585-276-5181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number25MA10899900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: