Provider Demographics
NPI:1104871680
Name:JANARDHANAN, THULASIRAM (MD)
Entity type:Individual
Prefix:
First Name:THULASIRAM
Middle Name:
Last Name:JANARDHANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 W 71ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4201
Mailing Address - Country:US
Mailing Address - Phone:718-245-2435
Mailing Address - Fax:718-245-2421
Practice Address - Street 1:KINGS COUNTY HOSPITAL CENTER
Practice Address - Street 2:450 CLARKSON AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:718-245-2435
Practice Address - Fax:718-245-2421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2206332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01959517Medicaid
NY01959517Medicaid
NYG94913Medicare UPIN