Provider Demographics
NPI:1255411716
Name:GOPAL, KRISHNAN (MD)
Entity type:Individual
Prefix:MR
First Name:KRISHNAN
Middle Name:
Last Name:GOPAL
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 1:723 NORTH BEERS STREET
Mailing Address - Street 2:STE 1E
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733
Mailing Address - Country:US
Mailing Address - Phone:732-739-8644
Mailing Address - Fax:732-739-4438
Practice Address - Street 1:723 NORTH BEERS STREET
Practice Address - Street 2:STE 1E
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-739-8644
Practice Address - Fax:732-739-4438
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42131207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E75322Medicare UPIN
419077NWJMedicare ID - Type Unspecified