Provider Demographics
NPI:1679607212
Name:MRANI, JAN G (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:G
Last Name:MRANI
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 1:175 WASHINGTON AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2936
Mailing Address - Country:US
Mailing Address - Phone:201-387-2003
Mailing Address - Fax:
Practice Address - Street 1:175 WASHINGTON AVE STE 17
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2936
Practice Address - Country:US
Practice Address - Phone:201-387-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62098207R00000X
AL38140207R00000X
NJMA06631600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7422903Medicaid
NJ004167Medicare PIN
NJ7422903Medicaid