Provider Demographics
NPI:1083607162
Name:GRANAS, ANDREW DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DANIEL
Last Name:GRANAS
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 1:140 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1847
Mailing Address - Country:US
Mailing Address - Phone:201-447-3603
Mailing Address - Fax:201-447-5184
Practice Address - Street 1:140 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1847
Practice Address - Country:US
Practice Address - Phone:201-447-3603
Practice Address - Fax:201-447-5184
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09331700207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ296867Medicare PIN
I22633Medicare UPIN
NY1342P1Medicare ID - Type Unspecified
NJ296867Medicare PIN