Provider Demographics
NPI:1992847024
Name:RANA, MUKTI
Entity Type:Individual
Prefix:DR
First Name:MUKTI
Middle Name:
Last Name:RANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-9518
Mailing Address - Country:US
Mailing Address - Phone:732-970-0295
Mailing Address - Fax:
Practice Address - Street 1:101 PROSPECT ST STE 112
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5004
Practice Address - Country:US
Practice Address - Phone:732-363-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2016102080P0208X
NJ25MA07335000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02164721Medicaid
NY0105LQMedicare ID - Type Unspecified
NY02164721Medicaid