MEDICARE: DR. PREETHI KRISHNAN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	255009	NY
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	35.127943	OH
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	25MA10429500	NJ

General Provider Information

NPI Number	:	1790904134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PREETHI KRISHNAN M.D

Provider Business Mailing Address
First Line	:	221 ENGLE ST
Second Line	:
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-2409
Country	:	US
Telephone Number	:	201-567-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 ENGLE ST
Second Line	:
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-2409
Country	:	US
Telephone Number	:	201-567-8999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	06/16/2021

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