Basic Information
Provider Information | |||||||||
NPI: | 1760461768 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KOLBOVSKY | ||||||||
FirstName: | IOSIF | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 210 WESTCHESTER AVE | ||||||||
Address2: | 3RD FLOOR | ||||||||
City: | WHITE PLAINS | ||||||||
State: | NY | ||||||||
PostalCode: | 106042901 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146813146 | ||||||||
FaxNumber: | 9146826403 | ||||||||
Practice Location | |||||||||
Address1: | 222 WESTCHESTER AVE | ||||||||
Address2: | SUITE 405 | ||||||||
City: | WHITE PLAINS | ||||||||
State: | NY | ||||||||
PostalCode: | 106042906 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146836474 | ||||||||
FaxNumber: | 9146826403 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/10/2006 | ||||||||
LastUpdateDate: | 10/16/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 455919-1 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 042936 | CT | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | 133884168 | 01 | NY | PHCS | OTHER | 0005947624 | 01 | NY | AETNA (NON HMO) | OTHER | 173AU1/173AU2 | 01 | NY | BLUE CROSS ALL PLANS | OTHER | 3399522 | 01 | NY | GHI PPO | OTHER | P670485 | 01 | NY | OXFORD | OTHER | 1829646 | 01 | NY | UNITED HEALTH CARE | OTHER | 01695629/0233897 | 05 | NY |   | MEDICAID | 133884168 | 01 | NY | EMPIR STATE PLAN (NYS) | OTHER | 133884168 | 01 | NY | POMCO | OTHER | 000000077243 | 01 | NY | GHI HMO | OTHER | 0D2976 | 01 | NY | HEALTH NET | OTHER | 133884168 | 01 | NY | BEECH STREET | OTHER | 133884168 | 01 | NY | CIGNA SPECIALTY | OTHER | 133884168 | 01 | NY | HIP | OTHER | 133884168 | 01 | NY | MULTIPLAN | OTHER | 3375645 | 01 | NY | AENTAN HMO | OTHER | 002989 | 01 | NY | CONNECTICARE | OTHER | 133884168 | 01 | NY | HORIZON HEALTHCARE OF NY | OTHER |