Provider Demographics
NPI:1538701313
Name:BHATT, KANAN H
Entity Type:Individual
Prefix:
First Name:KANAN
Middle Name:H
Last Name:BHATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RUTGERS LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7934
Mailing Address - Country:US
Mailing Address - Phone:609-508-2843
Mailing Address - Fax:
Practice Address - Street 1:29 RUTGERS LN
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7934
Practice Address - Country:US
Practice Address - Phone:609-508-2843
Practice Address - Fax:609-508-2843
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00966900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily