Provider Demographics
NPI:1669595310
Name:JADEJA, KIRANBEN J (MD)
Entity type:Individual
Prefix:DR
First Name:KIRANBEN
Middle Name:J
Last Name:JADEJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRANBA
Other - Middle Name:
Other - Last Name:JADEJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2010 SPRINGFIELD AVE
Mailing Address - Street 2:PRIME HEART BLDG
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3437
Mailing Address - Country:US
Mailing Address - Phone:732-762-1857
Mailing Address - Fax:
Practice Address - Street 1:2010 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3437
Practice Address - Country:US
Practice Address - Phone:732-762-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA082106002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ117174YWYMMedicare PIN