Basic Information
| Provider Information | |||||||||
| NPI: | 1760422521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAJAMANI | ||||||||
| FirstName: | KRISHNAKUMAR | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2655 RIDGEWAY AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146264285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853684560 | ||||||||
| FaxNumber: | 5853684565 | ||||||||
| Practice Location | |||||||||
| Address1: | 2655 RIDGEWAY AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146264285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853684560 | ||||||||
| FaxNumber: | 5853684565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 06/07/2016 | ||||||||
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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 | 207RE0101X | 186653 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 1866532B | 01 | NY | WORKER'S COMPENSATION | OTHER | 01252955 | 05 | NY | MEDICAID |