Provider Demographics
NPI:1891972758
Name:KRISHNAN, JAY ARACKAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ARACKAL
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAYAKRISHNAN
Other - Middle Name:
Other - Last Name:ARACKAL KRISHNAKURUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10619 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5831
Mailing Address - Country:US
Mailing Address - Phone:775-329-4600
Mailing Address - Fax:775-329-4992
Practice Address - Street 1:10619 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5831
Practice Address - Country:US
Practice Address - Phone:775-329-4600
Practice Address - Fax:775-329-4992
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19090207RG0100X
CAA111334207RG0100X
CT048163207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine