Provider Demographics
NPI:1548938319
Name:KOLMOS, LAURA (APN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KOLMOS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:HAZELGREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2185 LEMOINE AVE STE 1G
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6030
Mailing Address - Country:US
Mailing Address - Phone:877-959-8180
Mailing Address - Fax:
Practice Address - Street 1:2185 LEMOINE AVE STE 1G
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6030
Practice Address - Country:US
Practice Address - Phone:877-959-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-05
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01190100363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty