Healthcare Provider Details

I. General information

NPI: 1366425258
Provider Name (Legal Business Name): GANGA KRISHNAMURTHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

225 E 57TH ST APT 3K
NEW YORK NY
10022-2822
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-7250
  • Fax:
Mailing address:
  • Phone: 718-745-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number229274
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: