Provider Demographics
NPI:1871524264
Name:KOLIPAKAM, VANI S (MD)
Entity type:Individual
Prefix:
First Name:VANI
Middle Name:S
Last Name:KOLIPAKAM
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 1:160 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1229
Mailing Address - Country:US
Mailing Address - Phone:732-349-1977
Mailing Address - Fax:732-349-5553
Practice Address - Street 1:160 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1229
Practice Address - Country:US
Practice Address - Phone:732-349-1977
Practice Address - Fax:732-349-5553
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA047863002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7649509Medicaid
NJ730510BTMMedicare ID - Type Unspecified
NJ7649509Medicaid