Provider Demographics
NPI:1013213206
Name:PANCHANI, MRUGESH CHHAGANLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MRUGESH
Middle Name:CHHAGANLAL
Last Name:PANCHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 JACK MARTIN BLVD STE D1
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3063
Mailing Address - Country:US
Mailing Address - Phone:732-458-5854
Mailing Address - Fax:732-458-8012
Practice Address - Street 1:210 JACK MARTIN BLVD STE D1
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3063
Practice Address - Country:US
Practice Address - Phone:732-458-5854
Practice Address - Fax:732-458-8012
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09434600207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology