Healthcare Provider Details

I. General information

NPI: 1376472084
Provider Name (Legal Business Name): DINA KHANELES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 ALEXANDER RD STE 200
PRINCETON NJ
08540-6345
US

IV. Provider business mailing address

731 ALEXANDER RD STE 200
PRINCETON NJ
08540-6345
US

V. Phone/Fax

Practice location:
  • Phone: 609-921-9001
  • Fax: 215-741-3143
Mailing address:
  • Phone:
  • Fax: 215-741-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: