Provider Demographics
NPI:1417096942
Name:MITRA, RANJIT (MD)
Entity Type:Individual
Prefix:
First Name:RANJIT
Middle Name:
Last Name:MITRA
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 1:2366 SAINT GEORGE AVENUE
Mailing Address - Street 2:SAINT GEORGE BEHAVIORAL CARE
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065
Mailing Address - Country:US
Mailing Address - Phone:732-381-5700
Mailing Address - Fax:732-381-5827
Practice Address - Street 1:2366 SAINT GEORGE AVENUE
Practice Address - Street 2:SAINT GEORGE BEHAVIORAL CARE
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065
Practice Address - Country:US
Practice Address - Phone:732-381-5700
Practice Address - Fax:732-381-5827
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0636202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7663901Medicaid
NJ013277TJKMedicare ID - Type Unspecified
NJ7663901Medicaid