Provider Demographics
NPI:1750457693
Name:KOLLA, SAI SAMBA KRISHNA R (MD)
Entity Type:Individual
Prefix:
First Name:SAI
Middle Name:SAMBA KRISHNA R
Last Name:KOLLA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 SAINT PAULS AVE
Mailing Address - Street 2:15W
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3724
Mailing Address - Country:US
Mailing Address - Phone:201-333-8004
Mailing Address - Fax:201-333-8425
Practice Address - Street 1:2757 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-333-8004
Practice Address - Fax:201-333-8425
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA586342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology