Provider Demographics
NPI:1548216310
Name:KRISHNAMURTHY, SHANKER (MD)
Entity Type:Individual
Prefix:
First Name:SHANKER
Middle Name:
Last Name:KRISHNAMURTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 CROMPOND RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4146
Mailing Address - Country:US
Mailing Address - Phone:914-739-2121
Mailing Address - Fax:914-739-2185
Practice Address - Street 1:1985 CROMPOND RD
Practice Address - Street 2:MOUNT KISCO MEDICAL GROUP PC
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4146
Practice Address - Country:US
Practice Address - Phone:914-739-2121
Practice Address - Fax:914-739-2185
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1451061207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY200011443OtherRAILROAD MEDICARE
NYWS642OtherOXFORD
NY965490OtherMVP
NY49157OtherAETNA USHEALTHCARE
NY00751015Medicaid
NY0D5295OtherHEALTHNET
NY49157OtherAETNA USHEALTHCARE
NY00751015Medicaid