Healthcare Provider Details

I. General information

NPI: 1922532514
Provider Name (Legal Business Name): AYESHA KIRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 COBBLERS CIR
FRANKLIN PARK NJ
08823-1780
US

IV. Provider business mailing address

35 COBBLERS CIR
FRANKLIN PARK NJ
08823-1780
US

V. Phone/Fax

Practice location:
  • Phone: 718-355-0919
  • Fax:
Mailing address:
  • Phone: 718-355-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10775900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA10775900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: