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NPI Code Detail

MEDICARE: MRS. COLLEEN R KALMBACH PA

MEDICARE: MRS. COLLEEN R KALMBACH PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant006971NJ
2363A00000XPhysician Assistant25MP00048500NJ

General Provider Information

NPI Number : 1912175761
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COLLEEN R KALMBACH PA
Provider Business Mailing Address
First Line : PO BOX 416457
Second Line :
City : BOSTON
State : MA
Zip : 02241-6457
Country : US
Telephone Number : 844-362-1735
Fax Number : 973-290-7495
Provider Business Practice Location Address
First Line : 30 MORAN ST
Second Line :
City : NEWTON
State : NJ
Zip : 07860-1832
Country : US
Telephone Number : 862-246-9212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2008
Last Update Date : 11/04/2020

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