MEDICARE: KISHAN-HENAL LIMITED LIABILITY COMPANY

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	261QP2300X	Primary Care Clinic/Center	0400485692	NJ

General Provider Information

NPI Number	:	1720334550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISHAN-HENAL LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	223 GORDONS CORNER RD
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-1257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 COMMONS WAY
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-6429
Country	:	US
Telephone Number	:	732-228-7407
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HIMANSHU K PATEL
Credential	:	M.D.
Telephone Number	:	732-864-7324

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	12/11/2024

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