Provider Demographics
NPI:1295794105
Name:SUBRAMANI, KRISHNAIYER (MD)
Entity type:Individual
Prefix:
First Name:KRISHNAIYER
Middle Name:
Last Name:SUBRAMANI
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 1:500 MONTAUK HIGHWAY
Mailing Address - Street 2:SUTE B
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-422-4343
Mailing Address - Fax:631-661-3775
Practice Address - Street 1:500 MONTAUK HWY
Practice Address - Street 2:SUITE B
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4418
Practice Address - Country:US
Practice Address - Phone:631-422-4343
Practice Address - Fax:631-661-3775
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170817207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01191208Medicaid
NY71F703Medicare PIN
NY01191208Medicaid