Basic Information
| Provider Information | |||||||||
| NPI: | 1356397400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRISHNAIAH | ||||||||
| FirstName: | MAHESH | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2080 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112307359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182506915 | ||||||||
| FaxNumber: | 7182506489 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 WILLOUGHBY ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182506915 | ||||||||
| FaxNumber: | 7182506489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 222326 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 02277934 | 05 | NY | MEDICAID |