Provider Demographics
NPI:1235203654
Name:VASUDEVAN, PARVATHY KRISHNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVATHY
Middle Name:KRISHNAN
Last Name:VASUDEVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TURF LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2713
Mailing Address - Country:US
Mailing Address - Phone:516-484-2160
Mailing Address - Fax:516-484-5681
Practice Address - Street 1:1545 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1122
Practice Address - Country:US
Practice Address - Phone:718-613-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07500Medicare ID - Type UnspecifiedQUEENS
NY43K782Medicare ID - Type UnspecifiedBROOKLYN
NYF24003Medicare UPIN