1093909863 NPI number — JEANNE MARIE KOLLER L.C.S.W.

Table of content: JEANNE MARIE KOLLER L.C.S.W. (NPI 1093909863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093909863 NPI number — JEANNE MARIE KOLLER L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLLER
Provider First Name:
JEANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093909863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 412
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE SILVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07739-0412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-895-7227
Provider Business Mailing Address Fax Number:
732-577-1639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 W MAIN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-2144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-577-0740
Provider Business Practice Location Address Fax Number:
732-577-1639
Provider Enumeration Date:
09/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC00852500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)