Provider Demographics
NPI:1417069626
Name:PERUMAREDDI, KRISHNA S (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:S
Last Name:PERUMAREDDI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 AXINN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2139
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:233 NOSTRAND AVE
Practice Address - Street 2:CENTRAL BROOKLYN MEDICAL GROUP ATTN M. CHATHAM
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4924
Practice Address - Country:US
Practice Address - Phone:718-826-5948
Practice Address - Fax:718-564-2076
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-04-28
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Provider Licenses
StateLicense IDTaxonomies
NY224014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400029378Medicare PIN