Provider Demographics
NPI:1235426347
Name:KORYA, DANI (MD)
Entity Type:Individual
Prefix:DR
First Name:DANI
Middle Name:
Last Name:KORYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PALISADE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1108
Mailing Address - Country:US
Mailing Address - Phone:201-795-8596
Mailing Address - Fax:
Practice Address - Street 1:142 PALISADE AVE STE 200
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1108
Practice Address - Country:US
Practice Address - Phone:201-795-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48147208D00000X
AZAU-29035998302390200000X
NJ25MA095610002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0446572Medicaid
NJ0446572Medicaid