Provider Demographics
NPI:1245812569
Name:PATEL, ISHANI KIRANKUMAR (MD)
Entity type:Individual
Prefix:
First Name:ISHANI
Middle Name:KIRANKUMAR
Last Name:PATEL
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 1:557 CRANBURY RD STE 22
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5419
Mailing Address - Country:US
Mailing Address - Phone:732-613-0500
Mailing Address - Fax:733-463-6089
Practice Address - Street 1:557 CRANBURY RD STE 22
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5419
Practice Address - Country:US
Practice Address - Phone:732-613-0500
Practice Address - Fax:733-463-6089
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12781400207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty