Provider Demographics
NPI:1497932149
Name:KHANNA, PRAVIEN K (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:PRAVIEN
Middle Name:K
Last Name:KHANNA
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 VERONICA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5002
Mailing Address - Country:US
Mailing Address - Phone:732-247-7444
Mailing Address - Fax:732-247-5119
Practice Address - Street 1:75 VERONICA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5002
Practice Address - Country:US
Practice Address - Phone:732-247-7444
Practice Address - Fax:732-247-5119
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09252100207R00000X, 207RC0000X, 207RI0011X
NY264703-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0422088Medicaid
NJ0422088Medicaid