Provider Demographics
NPI:1891004222
Name:RADHAKRISHNAN, HARI (MD)
Entity Type:Individual
Prefix:DR
First Name:HARI
Middle Name:
Last Name:RADHAKRISHNAN
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 1:976 MCLEAN AVE
Mailing Address - Street 2:SUITE 387
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4105
Mailing Address - Country:US
Mailing Address - Phone:914-237-6797
Mailing Address - Fax:914-237-5152
Practice Address - Street 1:976 MCLEAN AVE
Practice Address - Street 2:SUITE 387
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4105
Practice Address - Country:US
Practice Address - Phone:914-237-6797
Practice Address - Fax:914-237-5152
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6593174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB122994Medicare PIN
TXTXB115472Medicare PIN
TXTXB130893Medicare PIN