Provider Demographics
NPI:1447231683
Name:KALYANARAMAN, GOPALSWAMY (DDS)
Entity type:Individual
Prefix:DR
First Name:GOPALSWAMY
Middle Name:
Last Name:KALYANARAMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2212
Mailing Address - Country:US
Mailing Address - Phone:516-326-2841
Mailing Address - Fax:718-789-6785
Practice Address - Street 1:361 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4103
Practice Address - Country:US
Practice Address - Phone:718-789-6300
Practice Address - Fax:718-789-6785
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0345531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00408342Medicaid