Provider Demographics
NPI:1275798167
Name:KOLLOORI & KOLLOORI, PHYSICIANS, LLC
Entity Type:Organization
Organization Name:KOLLOORI & KOLLOORI, PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:KOLLOORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-273-2929
Mailing Address - Street 1:1800 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1616
Mailing Address - Country:US
Mailing Address - Phone:718-273-2929
Mailing Address - Fax:718-876-9179
Practice Address - Street 1:1800 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1616
Practice Address - Country:US
Practice Address - Phone:718-273-2929
Practice Address - Fax:718-876-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty