Provider Demographics
NPI:1245216605
Name:KRISHNAN, JAYRAM (DO, MBA)
Entity type:Individual
Prefix:DR
First Name:JAYRAM
Middle Name:
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:136 ROUTE 73
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9598
Practice Address - Country:US
Practice Address - Phone:877-388-2778
Practice Address - Fax:856-424-7529
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08869800208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB08869800OtherNJ STATE MEDICAL LICENSE
NVDO1872OtherSTATE LICENSE