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General NPI Number Information
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NPI Number | 1275798167
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Entity Type | Organization
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Legal Business Name | KOLLOORI & KOLLOORI, PHYSICIANS, LLC
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 1800 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1616
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Country | US
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Telephone | 718-273-2929
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Fax | 718-876-9179
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Provider Business Mailing Address
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Address Line | 1800 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1616
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Country | US
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Telephone | 718-273-2929
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Fax | 718-876-9179
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN JOE KOLLOORI
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Credential | MD
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Telephone | 718-273-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 133887
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License Number State | NY
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