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General NPI Number Information
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NPI Number | 1922160290
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Entity Type | Individual
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Provider Name | RADHA T KRISHNAN MD
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 52 WOODLAND DR
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City | OYSTER BAY
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State | NY
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Zip | 11771-4108
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Country | US
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Telephone | 516-922-7521
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Fax | 516-624-8210
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Provider Business Mailing Address
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Address Line | 52 WOODLAND DR
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City | OYSTER BAY
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State | NY
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Zip | 11771-4108
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Country | US
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Telephone | 516-922-7521
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Fax | 516-624-8210
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 110448
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License Number State | NY
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