Healthcare Provider Details

I. General information

NPI: 1083607162
Provider Name (Legal Business Name): ANDREW DANIEL GRANAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 FRANKLIN TPKE
WALDWICK NJ
07463-1847
US

IV. Provider business mailing address

140 FRANKLIN TPKE
WALDWICK NJ
07463-1847
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-3603
  • Fax: 201-447-5184
Mailing address:
  • Phone: 201-447-3603
  • Fax: 201-447-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA09331700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: