Provider Demographics
NPI:1255499109
Name:JANI, BEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:BEENA
Middle Name:
Last Name:JANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WEST 158TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:646-429-8085
Mailing Address - Fax:
Practice Address - Street 1:85 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2449
Practice Address - Country:US
Practice Address - Phone:973-315-9076
Practice Address - Fax:973-376-0357
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230172-1207Q00000X
NJMA073669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH94743Medicare UPIN
NJ0577P1Medicare ID - Type Unspecified