Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 271517 | NY |
N | 207RI0011X | Interventional Cardiology | 271517 | NY |
NPI | 1013992601 |
---|---|
Provider Name | Vijay Kumar Krishnamoorthy |
First Address | Rochester, NY 14623-2808 |
Second Address | Rochester, NY 14623-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 24/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271517 | MEDICAL LICENSE (01) | NY |
390422900 | (05) | MN |
FK4043965 | DEA (01) | |
H94449 | (02) | MN |
P00054111 | MEDICARE RAILROAD (01) | MN |