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General NPI Number Information
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NPI Number | 1639793540
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Entity Type | Individual
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Provider Name | SHIVANI KHETANI MD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 22-18 BROADWAY STE 201
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City | FAIR LAWN
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State | NJ
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Zip | 07410-3016
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Country | US
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Telephone | 862-297-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 MCBRIDE AVE
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-3812
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Country | US
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Telephone | 973-812-0377
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | UTRESIDENT
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 25MA12757900
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License Number State | NJ
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