NPIMap

Individual provider Active NPI

Preethi Krishnan, M.D

  • Endocrinology, Diabetes & Metabolism Physician
  • Englewood, NJ
National Provider Identifier
1790904134
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
25MA10429500 Issued in NJ
Practice address
221 Engle St
Englewood, NJ 07631-2409
Phone
(201) 567-8999
NPI assigned
Apr 24, 2007
Last updated
Jun 16, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 255009 NY
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 35.127943 OH
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 25MA10429500 NJ Primary

Addresses

Primary practice location

221 Engle St
Englewood, NJ 07631-2409

Mailing address

221 Engle St
Englewood, NJ 07631-2409
Phone (201) 567-8999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190404000374 NJ Practitioner - EndocrinologyPractitioner - Internal Medicine 6800911959 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endocrinology Consultants, PCGroup PAC ID 0840387023, 9 clinicians

Practice addresses (Care Compare)

229 Engle St
Englewood, NJ 07631-2409
Phone (201) 567-8999

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.127943OHMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Endocrinology Consultants, P.C. Single Specialty CurrentSince Feb 11, 2019 Accepting new patients
Hillside Polymedic P.C. Single Specialty Past Accepting new patients
Licking Memorial Professional Corp. Single Specialty PastSince Dec 14, 2016 Accepting new patients
Hand Therapy Center, LLC PastSince Feb 11, 2019 Accepting new patients
Licking Memorial Professional Corp. Single Specialty Past Accepting new patients
Hillside Polymedic Diagnostic & Treatment Center Inc Single Specialty PastSince Apr 8, 2009 Accepting new patients
Astramed Physician PC Single Specialty Past Accepting new patients

Locations

221 Engle St
Englewood, NJ 07631
Phone (201) 567-8999

229 Engle St
Englewood, NJ 07631
Phone (201) 567-3674

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1790904134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 ENGLE ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312409",
            "telephone_number": "201-567-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 ENGLE ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312409",
            "telephone_number": "201-567-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRISHNAN",
        "first_name": "PREETHI",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "255009",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "OH",
            "license": "35.127943",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NJ",
            "license": "25MA10429500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, NJ

Sources for this page

Verify at the official NPI Registry.