Basic Information
| Provider Information | |||||||||
| NPI: | 1396018321 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. SANJA KOLAROV, MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 69 OLD ARMY RD | ||||||||
| Address2: | |||||||||
| City: | BERNARDSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079241847 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 69 OLD ARMY RD | ||||||||
| Address2: | |||||||||
| City: | BERNARDSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079241847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2012 | ||||||||
| LastUpdateDate: | 02/22/2012 | ||||||||
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| AuthorizedOfficialLastName: | KOLAROV | ||||||||
| AuthorizedOfficialFirstName: | SANJA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6096380788 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA08342400 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.