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General NPI Number Information
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NPI Number | 1053938340
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Entity Type | Individual
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Provider Name | SUSAN M KOLB NP
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Gender | Female
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 5584 EAST MAIN STREET
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City | VERONA
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State | NY
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Zip | 13478
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Country | US
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Telephone | 315-473-3300
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Fax | 315-473-3847
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Provider Business Mailing Address
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Address Line | 251 SALINA MEADOWS PARKWAY SUITE 100
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City | SYRACUSE
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State | NY
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Zip | 13212
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Country | US
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Telephone | 315-464-2000
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Fax | 315-464-2010
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F346052-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 346052
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License Number State | NY
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