Healthcare Provider Details

I. General information

NPI: 1306643242
Provider Name (Legal Business Name): KINJALBEN MOUNESH SHUKLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WESTFIELD AVE, 2 WESTFEILD AVE
CLARK NJ
07066
US

IV. Provider business mailing address

2 WESTFIELD AVE
CLARK NJ
07066-3226
US

V. Phone/Fax

Practice location:
  • Phone: 908-505-5141
  • Fax: 908-208-6492
Mailing address:
  • Phone: 732-357-6437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15284400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: