=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295722601
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRETT ROLAND KOLLMEIER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2005
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1945 STATE ROUTE 33
-----------------------------------------------------
City | NEPTUNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07753-4859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-776-4945
-----------------------------------------------------
Fax | 732-776-4550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1204 BIRCH AVE
-----------------------------------------------------
City | YARDLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19067-7428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-428-1021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 25MA07816100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------