Provider Demographics
NPI:1174523021
Name:KRISHNA, SRINIVASAN (MD)
Entity type:Individual
Prefix:
First Name:SRINIVASAN
Middle Name:
Last Name:KRISHNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SELWYN AVE
Mailing Address - Street 2:SUITE 11C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7626
Mailing Address - Country:US
Mailing Address - Phone:718-866-8161
Mailing Address - Fax:718-518-5785
Practice Address - Street 1:1650 SELWYN AVE
Practice Address - Street 2:11C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7626
Practice Address - Country:US
Practice Address - Phone:718-866-8161
Practice Address - Fax:718-518-5785
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY235552207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I23548Medicare UPIN