Provider Demographics
NPI:1912014887
Name:KORKIS, ANNA M (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:KORKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5003
Mailing Address - Country:US
Mailing Address - Phone:201-444-0009
Mailing Address - Fax:201-444-2181
Practice Address - Street 1:200 S BROAD ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5003
Practice Address - Country:US
Practice Address - Phone:201-444-0009
Practice Address - Fax:201-444-2181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA054387207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF01246Medicare UPIN
NJ690873Medicare ID - Type Unspecified