Provider Demographics
NPI:1447606082
Name:KOLLIPARA, KARISHMA (DO)
Entity Type:Individual
Prefix:
First Name:KARISHMA
Middle Name:
Last Name:KOLLIPARA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MASON AVE BLDG B2ND
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3408
Mailing Address - Country:US
Mailing Address - Phone:187-226-6790
Mailing Address - Fax:718-226-7950
Practice Address - Street 1:256 MASON AVE BLDG B2ND
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3408
Practice Address - Country:US
Practice Address - Phone:187-226-6790
Practice Address - Fax:718-226-7950
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY308764208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program