Provider Demographics
NPI:1194771162
Name:BADHEY, KRISHNA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:RAO
Last Name:BADHEY
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 1:28 NOEL LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1316
Mailing Address - Country:US
Mailing Address - Phone:516-353-4044
Mailing Address - Fax:
Practice Address - Street 1:4902 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4444
Practice Address - Country:US
Practice Address - Phone:718-424-4646
Practice Address - Fax:718-424-4348
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177666207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011511995Medicaid
NYE38148Medicare UPIN
NY44924Medicare ID - Type Unspecified