Provider Demographics
NPI:1689156291
Name:MAKANI, EKTA H
Entity Type:Individual
Prefix:
First Name:EKTA
Middle Name:H
Last Name:MAKANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EKTABAHEN
Other - Middle Name:H
Other - Last Name:MAKANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 LEXI LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 DUNDEE AVE
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2118
Practice Address - Country:US
Practice Address - Phone:732-404-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00846200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily