Healthcare Provider Details

I. General information

NPI: 1588528236
Provider Name (Legal Business Name): KANAN A PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N FRONT ST UNIT 4
PHILADELPHIA PA
19123-0001
US

IV. Provider business mailing address

412 N FRONT ST UNIT 4
PHILADELPHIA PA
19123-0001
US

V. Phone/Fax

Practice location:
  • Phone: 732-397-7939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG11250035
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: