MEDICARE: ISHANI KIRANKUMAR PATEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA12781400	NJ
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1245812569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISHANI KIRANKUMAR PATEL MD

Provider Business Mailing Address
First Line	:	557 CRANBURY RD STE 22
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-5419
Country	:	US
Telephone Number	:	732-613-0500
Fax Number	:	733-463-6089

Provider Business Practice Location Address
First Line	:	557 CRANBURY RD STE 22
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-5419
Country	:	US
Telephone Number	:	732-613-0500
Fax Number	:	733-463-6089

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	12/05/2025

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