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General NPI Number Information
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NPI Number | 1144528142
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Entity Type | Organization
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Legal Business Name | ANNA M. KORKIS MD PA
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 206 DAYTON ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4409
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Country | US
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Telephone | 201-444-0009
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Fax | 201-444-2181
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Provider Business Mailing Address
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Address Line | 206 DAYTON ST PO BOX 0495
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4409
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Country | US
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Telephone | 201-444-0009
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Fax | 201-444-2181
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | ANNA M KORKIS
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Credential | MD
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Telephone | 201-444-0009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MA054387
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License Number State | NJ
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