Provider Demographics
NPI:1740603133
Name:GOPALA KRISHNAN, KARTHIGAYEN
Entity Type:Individual
Prefix:
First Name:KARTHIGAYEN
Middle Name:
Last Name:GOPALA KRISHNAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 YONKERS AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3070
Mailing Address - Country:US
Mailing Address - Phone:914-294-0080
Mailing Address - Fax:
Practice Address - Street 1:1019 YONKERS AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3070
Practice Address - Country:US
Practice Address - Phone:914-294-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ735M1OtherEMPIRE BLUE CROSS & BLUE SHIELD PIN
NY1001710OtherCIGNA PIN
NY1467595Other1199 PIN
NY7612982OtherAETNA PIN
NY013132OtherOPTUM (UHC COMMUNITY PLAN)
NY1001710OtherUS FAMILY HEALTH PLAN
NY7612982OtherAETNA PIN