Provider Demographics
NPI:1235174616
Name:GOBIKRISHNA PHYSICIAN PC
Entity Type:Organization
Organization Name:GOBIKRISHNA PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:ARIARATNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBIKRISHNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-345-8015
Mailing Address - Street 1:379 KNOLLWOOD ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-2910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:623 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2801
Practice Address - Country:US
Practice Address - Phone:718-325-5368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194921-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01466320Medicaid
NYF75816Medicare UPIN
NY71I613Medicare ID - Type Unspecified