Provider Demographics
NPI:1407419641
Name:MATLANI, KRUTI JAYESH
Entity Type:Individual
Prefix:
First Name:KRUTI
Middle Name:JAYESH
Last Name:MATLANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRUTI
Other - Middle Name:JAYESH
Other - Last Name:BALSARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:333 LAUREL OAK RD STE B
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4453
Mailing Address - Country:US
Mailing Address - Phone:565-134-1248
Mailing Address - Fax:609-441-8907
Practice Address - Street 1:435 HURFFVILLE CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2453
Practice Address - Country:US
Practice Address - Phone:856-513-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11450800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine