Provider Demographics
NPI:1043311145
Name:RAND, DOV JOHANAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOV
Middle Name:JOHANAN
Last Name:RAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2403
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-2403
Mailing Address - Country:US
Mailing Address - Phone:973-831-2828
Mailing Address - Fax:973-831-2829
Practice Address - Street 1:2035 HAMBURG TPKE
Practice Address - Street 2:SUITE G
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6251
Practice Address - Country:US
Practice Address - Phone:973-831-2828
Practice Address - Fax:973-831-2829
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6543006Medicaid
NJ6543006Medicaid
NJ111876Medicare PIN
NJ044920Medicare ID - Type UnspecifiedRMCNJ
NJF34244Medicare UPIN