Provider Demographics
NPI:1710611108
Name:CROOKE, KRIZIA THAIS
Entity Type:Individual
Prefix:
First Name:KRIZIA
Middle Name:THAIS
Last Name:CROOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E 7TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-5757
Mailing Address - Country:US
Mailing Address - Phone:817-797-2046
Mailing Address - Fax:
Practice Address - Street 1:117 E 7TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-5757
Practice Address - Country:US
Practice Address - Phone:817-797-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86118855133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered