Provider Demographics
NPI:1275989444
Name:BARAN, ANI (LAC)
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:BARAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:
Other - Last Name:PETROSYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 W 30TH ST
Mailing Address - Street 2:APT 302
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1876
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:551 NEWARK AVE
Practice Address - Street 2:STE 201
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1307
Practice Address - Country:US
Practice Address - Phone:201-668-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00119800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist