Provider Demographics
NPI:1386745867
Name:JAYAKRISHNAN, VELLORE PADMANABAN (MD)
Entity type:Individual
Prefix:
First Name:VELLORE
Middle Name:PADMANABAN
Last Name:JAYAKRISHNAN
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 1:355 OVINGTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1459
Mailing Address - Country:US
Mailing Address - Phone:718-748-4871
Mailing Address - Fax:718-833-3940
Practice Address - Street 1:355 OVINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1459
Practice Address - Country:US
Practice Address - Phone:718-748-4871
Practice Address - Fax:718-833-3940
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128925208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12989Medicare UPIN