Provider Demographics
NPI:1740545326
Name:DE THABREW, KRISHNI (MD)
Entity type:Individual
Prefix:
First Name:KRISHNI
Middle Name:
Last Name:DE THABREW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E PALISADE AVE STE 2-162
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1830
Mailing Address - Country:US
Mailing Address - Phone:609-941-2580
Mailing Address - Fax:
Practice Address - Street 1:650 E PALISADE AVE STE 2-162
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-1830
Practice Address - Country:US
Practice Address - Phone:609-941-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2516822084P0800X
NY2867902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry