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General NPI Number Information
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NPI Number | 1508829284
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Entity Type | Individual
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Provider Name | KRISHNA VIJAY PERSAUD MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 4418 E RIDGE RD WILLIAMSON MEDICAL PLLC
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City | WILLIAMSON
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State | NY
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Zip | 14589-9375
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Country | US
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Telephone | 315-589-4641
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Fax | 315-589-9585
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Provider Business Mailing Address
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Address Line | 4418 E RIDGE RD
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City | WILLIAMSON
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State | NY
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Zip | 14589-9375
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Country | US
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Telephone | 315-589-4641
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Fax | 315-589-9585
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 205585
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 205585
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License Number State | NY
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