MEDICARE: SRINIVASAN KRISHNA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	235552	NY

General Provider Information

NPI Number	:	1174523021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRINIVASAN KRISHNA MD

Provider Business Mailing Address
First Line	:	1650 SELWYN AVE
Second Line	:	SUITE 11C
City	:	BRONX
State	:	NY
Zip	:	10457-7626
Country	:	US
Telephone Number	:	718-866-8161
Fax Number	:	718-518-5785

Provider Business Practice Location Address
First Line	:	1650 SELWYN AVE
Second Line	:	11C
City	:	BRONX
State	:	NY
Zip	:	10457-7626
Country	:	US
Telephone Number	:	718-866-8161
Fax Number	:	718-518-5785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/03/2007

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