Provider Demographics
NPI:1609395193
Name:MAHTANI, BEENA G (DNP)
Entity Type:Individual
Prefix:DR
First Name:BEENA
Middle Name:G
Last Name:MAHTANI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 GREEN POND RD STE C
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2057
Mailing Address - Country:US
Mailing Address - Phone:973-625-0600
Mailing Address - Fax:973-625-3434
Practice Address - Street 1:35 GREEN POND RD STE C
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2057
Practice Address - Country:US
Practice Address - Phone:973-625-0600
Practice Address - Fax:973-625-3434
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00762300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily