MEDICARE: MOHINI KRISHNAN

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	309913	NY

General Provider Information

NPI Number	:	1962999094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHINI KRISHNAN

Provider Business Mailing Address
First Line	:	1919 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7710
Country	:	US
Telephone Number	:	602-933-0945
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 DEAN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-2201
Country	:	US
Telephone Number	:	212-226-7666
Fax Number	:

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

Provider Enumeration Date	:	04/14/2018
Last Update Date	:	10/07/2022

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