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General NPI Number Information
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NPI Number | 1104680735
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Entity Type | Individual
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Provider Name | EDWARD KOLLAR PTA
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Gender | Male
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 462 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-9196
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Country | US
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Telephone | 212-562-7059
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 23RD RD FL 2
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City | ASTORIA
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State | NY
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Zip | 11105-3423
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Country | US
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Telephone | 917-834-2828
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 011499
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License Number State | NY
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