MEDICARE: GOBIKRISHNA PHYSICIAN PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	194921-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235174616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOBIKRISHNA PHYSICIAN PC

Provider Business Mailing Address
First Line	:	379 KNOLLWOOD ROAD EXT
Second Line	:
City	:	ELMSFORD
State	:	NY
Zip	:	10523-2910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 E 233RD ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2801
Country	:	US
Telephone Number	:	718-325-5368
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETER
Name	:	ARIARATNAM GOBIKRISHNA
Credential	:
Telephone Number	:	914-345-8015

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	09/17/2009

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