Healthcare Provider Details

I. General information

NPI: 1174523021
Provider Name (Legal Business Name): SRINIVASAN KRISHNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SELWYN AVE 11C
BRONX NY
10457-7626
US

IV. Provider business mailing address

1650 SELWYN AVE SUITE 11C
BRONX NY
10457-7626
US

V. Phone/Fax

Practice location:
  • Phone: 718-866-8161
  • Fax: 718-518-5785
Mailing address:
  • Phone: 718-866-8161
  • Fax: 718-518-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number235552
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: