Provider Demographics
NPI:1285785741
Name:KRISHNARAJ, VEERASWAMY (MD)
Entity type:Individual
Prefix:DR
First Name:VEERASWAMY
Middle Name:
Last Name:KRISHNARAJ
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 1:271 TYSENS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2162
Mailing Address - Country:US
Mailing Address - Phone:718-667-0732
Mailing Address - Fax:
Practice Address - Street 1:1235 ARDEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-4148
Practice Address - Country:US
Practice Address - Phone:718-948-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105529208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics