Provider Demographics
NPI:1710192505
Name:USHA KRISHNAMURTHY MD PC
Entity Type:Organization
Organization Name:USHA KRISHNAMURTHY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAMURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-461-0017
Mailing Address - Street 1:5516 MAIN ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5098
Mailing Address - Country:US
Mailing Address - Phone:718-461-0017
Mailing Address - Fax:718-461-0018
Practice Address - Street 1:5516 MAIN ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5098
Practice Address - Country:US
Practice Address - Phone:718-461-0017
Practice Address - Fax:718-461-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152595207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05753Medicare ID - Type Unspecified