Healthcare Provider Details

I. General information

NPI: 1770921132
Provider Name (Legal Business Name): PRIYA MENON KRISHNARAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRIYA MENON MD

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE FL 2
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

2489 N LA CAPELLA CT
ORANGE CA
92867-1918
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5230
  • Fax: 646-754-9560
Mailing address:
  • Phone: 267-879-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA127418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: