Doctor Name: | KRISHNA KISHORE BEZWADA |
NPI Number: | 1346458478 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 0116016255 |
Business Practice Address: | 327 Beach 19th Street St. John's Episcopal Hospital Far Rockaway, NY - 11691 |
Business Phone Number: | 5169841646 |
Business Fax Number: | |
Mailing Address: | 48 Dolphin Ln E, COPIAGUE |
State: | NY |
Postal Code: | 117265413 |
Phone Number: | 5169841646 |
Fax Number: | |
NPI Enumeration Date: | 05/21/2007 |
NPI Last Update Date: | 03/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 0116016255 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |