Healthcare Provider Details

I. General information

NPI: 1871524264
Provider Name (Legal Business Name): VANI S. KOLIPAKAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ATLANTIC CITY BLVD
BAYVILLE NJ
08721-1229
US

IV. Provider business mailing address

160 ATLANTIC CITY BLVD
BAYVILLE NJ
08721-1229
US

V. Phone/Fax

Practice location:
  • Phone: 732-349-1977
  • Fax: 732-349-5553
Mailing address:
  • Phone: 732-349-1977
  • Fax: 732-349-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA04786300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: