Provider Demographics
NPI:1275975476
Name:AHLES, RAYMOND J (LAC/ DIPLOM)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:AHLES
Suffix:
Gender:M
Credentials:LAC/ DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2324
Mailing Address - Country:US
Mailing Address - Phone:201-385-3130
Mailing Address - Fax:201-385-9688
Practice Address - Street 1:53 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2324
Practice Address - Country:US
Practice Address - Phone:201-385-3130
Practice Address - Fax:201-385-9688
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMZ00016600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist