Provider Demographics
NPI:1811911134
Name:MISHRA, RANI (MD)
Entity type:Individual
Prefix:DR
First Name:RANI
Middle Name:
Last Name:MISHRA
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 1:158-06 GRAND CENTRAL PARK WAY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1127
Mailing Address - Country:US
Mailing Address - Phone:718-739-1111
Mailing Address - Fax:718-739-3838
Practice Address - Street 1:158-06 GRAND CENTRAL PARK WAY
Practice Address - Street 2:
Practice Address - City:JAMAICA HILLS
Practice Address - State:NY
Practice Address - Zip Code:11432-1127
Practice Address - Country:US
Practice Address - Phone:718-739-1111
Practice Address - Fax:718-739-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1539731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00901675Medicaid
NY00901675Medicaid
NYA62631Medicare UPIN