Active NPI
Peter Kolb, PA
- Physician Assistant
- Brooklyn, NY
National Provider Identifier
1700961992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 002757-1
- Practice address
- 4802 10TH Ave
Emergency Dept.
Brooklyn, NY 11219-2916 - Phone
- (718) 283-8793
- Fax
- (718) 283-8713
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 002757-1 | NY | Primary |
Addresses
Primary practice location
4802 10TH Ave
Emergency Dept.
Brooklyn, NY 11219-2916
Mailing address
702 Deal Rd
Ocean, NJ 07712-3508
Phone (732) 804-9222
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002757-1 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700961992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 DEAL RD",
"city": "OCEAN",
"state": "NJ",
"postal_code": "077123508",
"telephone_number": "732-804-9222",
"fax_number": "732-531-5507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4802 10TH AVE",
"address_2": "EMERGENCY DEPT.",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112192916",
"telephone_number": "718-283-8793",
"fax_number": "718-283-8713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLB",
"first_name": "PETER",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "002757-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.