Healthcare Provider Details

I. General information

NPI: 1992847024
Provider Name (Legal Business Name): DR. MUKTI RANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PROSPECT ST STE 112
LAKEWOOD NJ
08701-5004
US

IV. Provider business mailing address

255 NOTTINGHAM RD
MORGANVILLE NJ
07751-9518
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-1424
  • Fax:
Mailing address:
  • Phone: 732-970-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07335000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number201610
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: