Provider Demographics
NPI:1457584971
Name:ANITA KISHEN MD LLC
Entity Type:Organization
Organization Name:ANITA KISHEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KISHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-889-4932
Mailing Address - Street 1:1743 RAMAPO WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2319
Mailing Address - Country:US
Mailing Address - Phone:908-889-4932
Mailing Address - Fax:
Practice Address - Street 1:805 INMAN AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-1433
Practice Address - Country:US
Practice Address - Phone:908-821-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08017500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty