Provider Demographics
NPI:1215126693
Name:KANANI, BHAKTI NARESH (MSPA, PA-C)
Entity type:Individual
Prefix:MRS
First Name:BHAKTI
Middle Name:NARESH
Last Name:KANANI
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Gender:F
Credentials:MSPA, PA-C
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Mailing Address - Street 1:28 THROCKMORTON LN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2558
Mailing Address - Country:US
Mailing Address - Phone:732-679-6300
Mailing Address - Fax:732-679-9566
Practice Address - Street 1:28 THROCKMORTON LN
Practice Address - Street 2:SUITE 204
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2558
Practice Address - Country:US
Practice Address - Phone:732-679-6300
Practice Address - Fax:732-679-9566
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2014-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00190500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOTH000Medicare UPIN
NJ158470C2HMedicare PIN