Individual provider Active NPI

Samet Kucukcolak

  • Anatomic Pathology & Clinical Pathology Physician
  • New Brunswick, NJ
National Provider Identifier
1083294425
Registry record updated Jun 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
25MA12628100 Issued in NJ
Practice address
330 Livingston Ave Ste 221
New Brunswick, NJ 08901-3469
Phone
(732) 543-0600
NPI assigned
Apr 9, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 25MA12628100 NJ Primary

Addresses

Primary practice location

330 Livingston Ave Ste 221
New Brunswick, NJ 08901-3469

Mailing address

524 Bluff Rd
Fort Lee, NJ 07024-1543
Phone (201) 616-9188

Other practice location 1

524 Bluff Rd
Fort Lee, NJ 07024-1543
Phone (201) 616-9188

Other practice location 2

1 Robert Wood Johnson Pl
New Brunswick, NJ 08901-1928
Phone (732) 235-8118

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
25MA12628100NJMDAnatomic Pathology & Clinical Pathology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1083294425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 BLUFF RD",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070241543",
            "telephone_number": "201-616-9188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 LIVINGSTON AVE STE 221",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089013469",
            "telephone_number": "732-543-0600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "524 Bluff Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Lee",
            "state": "NJ",
            "postal_code": "070241543",
            "country_code": "US",
            "telephone_number": "201-616-9188",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Robert Wood Johnson Pl",
            "address_purpose": "LOCATION",
            "city": "New Brunswick",
            "state": "NJ",
            "postal_code": "089011928",
            "country_code": "US",
            "telephone_number": "732-235-8118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUCUKCOLAK",
        "first_name": "SAMET",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-09",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NJ",
            "license": "25MA12628100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Brunswick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.