Provider Demographics
NPI:1710918115
Name:KRISH, NAGESH B (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:NAGESH
Middle Name:B
Last Name:KRISH
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-0691
Mailing Address - Country:US
Mailing Address - Phone:201-864-5252
Mailing Address - Fax:201-864-9955
Practice Address - Street 1:727 1OTH STREET
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-864-5252
Practice Address - Fax:201-864-9955
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0620342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6532306Medicaid
NJKR685352Medicare ID - Type Unspecified
NJ6532306Medicaid