Provider Demographics
NPI:1407959281
Name:PATRAWALLA, KANAN S (MD)
Entity Type:Individual
Prefix:MRS
First Name:KANAN
Middle Name:S
Last Name:PATRAWALLA
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 1:33 OVERLOOK RD.
Mailing Address - Street 2:STE. 210
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901
Mailing Address - Country:US
Mailing Address - Phone:908-598-0390
Mailing Address - Fax:908-273-0815
Practice Address - Street 1:33 OVERLOOK RD.
Practice Address - Street 2:SUITE 210
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-598-0390
Practice Address - Fax:908-273-0815
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA350342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C55227Medicare UPIN
NJPA451598Medicare PIN