Organization
MAHADEVAN G KRISHNAN, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAHADEVAN G KRISHNAN MD (PRESIDENT)
(732) 901-8822
Entity
Organization
Contact information
Practice address
609 RIVER AVE, LAKEWOOD, NJ 08701-5227
(732) 901-8822
(732) 367-2897
Mailing address
609 RIVER AVE, LAKEWOOD, NJ 08701-5227
(732) 901-8822
(732) 367-2897
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
25MA045854
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB3539
RAILROAD MEDICARE
NJ
Enumeration date
11/17/2006
Last updated
11/28/2012
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