Healthcare Provider Details

I. General information

NPI: 1932225489
Provider Name (Legal Business Name): AJAY MIRANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/21/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 NASSAU ST # 9050
NEW YORK NY
10038-3703
US

IV. Provider business mailing address

82 NASSAU ST # 9050
NEW YORK NY
10038-3703
US

V. Phone/Fax

Practice location:
  • Phone: 917-994-7613
  • Fax: 917-730-9141
Mailing address:
  • Phone: 917-994-7613
  • Fax: 917-730-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number237206
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number237206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: