Basic Information
| Provider Information | |||||||||
| NPI: | 1366484768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | URS | ||||||||
| FirstName: | KRISHNA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 JAMES ST | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088203947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323217070 | ||||||||
| FaxNumber: | 7323217330 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 JAMES ST | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088203947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323217070 | ||||||||
| FaxNumber: | 7323217330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 01/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA07947100 | NJ | N | Other Service Providers | Specialist | 208100000X | 25MA07947100 | NJ | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 7736304 | 05 | NJ | MEDICAID |