Provider Demographics
NPI:1801852793
Name:KRISHNAMURTHY, MUTHUSWAMY (MD)
Entity Type:Individual
Prefix:
First Name:MUTHUSWAMY
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:PO BOX 7490
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:718-780-3877
Mailing Address - Fax:718-780-7369
Practice Address - Street 1:501 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NJ
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-3877
Practice Address - Fax:718-780-7369
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122793207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00325571Medicaid
NY00325571Medicaid
NY341151Medicare PIN