Provider Demographics
NPI:1700846185
Name:KRISHNAN, RAJMANI (MD)
Entity Type:Individual
Prefix:
First Name:RAJMANI
Middle Name:
Last Name:KRISHNAN
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 1:93 LONE OAK PATH
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4280
Mailing Address - Country:US
Mailing Address - Phone:631-432-5940
Mailing Address - Fax:
Practice Address - Street 1:93 LONE OAK PATH
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4280
Practice Address - Country:US
Practice Address - Phone:631-432-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225329207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02551820Medicaid
NY9K8731Medicare PIN
NYI03857Medicare UPIN