Provider Demographics
NPI:1144423161
Name:SUNANDA KRISHNA, M.D., LLC
Entity Type:Organization
Organization Name:SUNANDA KRISHNA, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-240-0303
Mailing Address - Street 1:3 PLAZA DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3759
Mailing Address - Country:US
Mailing Address - Phone:732-240-0303
Mailing Address - Fax:732-240-2430
Practice Address - Street 1:3 PLAZA DR
Practice Address - Street 2:SUITE 14
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3759
Practice Address - Country:US
Practice Address - Phone:732-240-0303
Practice Address - Fax:732-240-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8583901Medicaid
NJ180499Medicare PIN