Provider Demographics
NPI:1982930046
Name:KRISHNA, MARYALA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARYALA
Middle Name:
Last Name:KRISHNA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BELLEVUE HOSPITAL 462 FIRST AVENUE
Mailing Address - Street 2:RM 4W1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-263-6454
Mailing Address - Fax:
Practice Address - Street 1:BELLEVUE HOSPITAL 462 FIRST AVENUE
Practice Address - Street 2:RM 4W1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-263-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCOQKRISM1246ZG1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZG1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGeneticist, Medical (PhD)