Provider Demographics
NPI:1144528142
Name:ANNA M. KORKIS MD PA
Entity type:Organization
Organization Name:ANNA M. KORKIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KORKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-0009
Mailing Address - Street 1:206 DAYTON ST
Mailing Address - Street 2:PO BOX 0495
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4409
Mailing Address - Country:US
Mailing Address - Phone:201-444-0009
Mailing Address - Fax:201-444-2181
Practice Address - Street 1:206 DAYTON ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4409
Practice Address - Country:US
Practice Address - Phone:201-444-0009
Practice Address - Fax:201-444-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA054387207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty