Provider Demographics
NPI:1750491015
Name:COLLUR, SUREKHA (MD)
Entity type:Individual
Prefix:DR
First Name:SUREKHA
Middle Name:
Last Name:COLLUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:719 N BEERS ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1522
Mailing Address - Country:US
Mailing Address - Phone:732-264-6464
Mailing Address - Fax:732-264-5114
Practice Address - Street 1:719 N BEERS ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1522
Practice Address - Country:US
Practice Address - Phone:732-264-6464
Practice Address - Fax:732-264-5114
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07128400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8423105Medicaid
NJ8423105Medicaid
NJH06223Medicare UPIN