Provider Demographics
NPI:1124553557
Name:AUROURA HEALTH & AESTHETICS
Entity Type:Organization
Organization Name:AUROURA HEALTH & AESTHETICS
Other - Org Name:AUROURA COMPREHENSIVE HEALTH, PSYCHIATRY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INTISAR
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, PNHNP-BC
Authorized Official - Phone:201-233-2999
Mailing Address - Street 1:35 RAMELLA AVE
Mailing Address - Street 2:
Mailing Address - City:MOONACHIE
Mailing Address - State:NJ
Mailing Address - Zip Code:07074-1105
Mailing Address - Country:US
Mailing Address - Phone:201-233-2999
Mailing Address - Fax:
Practice Address - Street 1:318 21ST AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-3538
Practice Address - Country:US
Practice Address - Phone:201-233-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty