Provider Demographics
NPI:1417316332
Name:RANIERI, DEREK D (CNIM)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:D
Last Name:RANIERI
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4854
Mailing Address - Country:US
Mailing Address - Phone:484-351-8459
Mailing Address - Fax:484-351-8810
Practice Address - Street 1:1086 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4854
Practice Address - Country:US
Practice Address - Phone:484-351-8459
Practice Address - Fax:484-351-8810
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2122246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic