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General NPI Number Information
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NPI Number | 1407929185
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Entity Type | Organization
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Legal Business Name | MAHADEVAN G KRISHNAN, MD PC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 609 RIVER AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5227
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Country | US
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Telephone | 732-901-8822
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Fax | 732-367-2897
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Provider Business Mailing Address
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Address Line | 609 RIVER AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5227
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Country | US
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Telephone | 732-901-8822
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Fax | 732-367-2897
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHADEVAN G KRISHNAN
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Credential | MD
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Telephone | 732-901-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 25MA045854
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License Number State | NJ
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