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General NPI Number Information
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NPI Number | 1588244149
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Entity Type | Individual
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Provider Name | VIJAY KUMAR KOLLURI MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 95 OLD SHORT HILLS RD
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1008
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Country | US
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Telephone | 908-376-3827
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Fax |
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Provider Business Mailing Address
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Address Line | 8 SENECA LN
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City | HORSHAM
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State | PA
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Zip | 19044-1263
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Country | US
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Telephone | 732-682-4413
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA12457100
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License Number State | NJ
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