Provider Demographics
NPI:1588239917
Name:UKRANI, JANTA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:JANTA
Middle Name:D
Last Name:UKRANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N COUNTRT RD.
Mailing Address - Street 2:CMO SUITE
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-972-7566
Mailing Address - Fax:631-686-7651
Practice Address - Street 1:75 N COUNTY RD MATHER HOSTPITAL
Practice Address - Street 2:CMO SUITE
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-972-7566
Practice Address - Fax:631-686-7651
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2023-12-12
Deactivation Date:2022-11-25
Deactivation Code:
Reactivation Date:2023-12-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program