Basic Information
| Provider Information | |||||||||
| NPI: | 1649739947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANANI | ||||||||
| FirstName: | ANITABEN | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34 MOUNTAIN BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070592640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083155070 | ||||||||
| FaxNumber: | 9084849646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2019 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 26NJ00911100 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP2300X | 26NJ00911100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.