=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477548550
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC LEWIS KOLODIN DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2005
-----------------------------------------------------
Last Update Date | 04/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35-37 PROGRESS ST A3
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820-1179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-458-3928
-----------------------------------------------------
Fax | 908-668-4845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35-37 PROGRESS ST A3
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820-1179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-458-3928
-----------------------------------------------------
Fax | 908-668-4845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 25MD00166300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------