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General NPI Number Information
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NPI Number | 1447430244
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Entity Type | Individual
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Provider Name | MANISH PRAVIN KHETANI M.D
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Gender | Male
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 55-77 SCHANCK RD STE B-13
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City | FREEHOLD
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State | NJ
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Zip | 07728-2964
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Country | US
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Telephone | 732-612-8485
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Fax |
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Provider Business Mailing Address
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Address Line | 10 TURNBERRY DR
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City | MANALAPAN
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State | NJ
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Zip | 07726-9315
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Country | US
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Telephone | 732-446-1089
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA08344200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA08344200
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License Number State | NJ
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