Provider Demographics
NPI:1417171489
Name:AARYA CHIROPRACTIC L.L.C.
Entity Type:Organization
Organization Name:AARYA CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRABHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-217-1224
Mailing Address - Street 1:3523 JOHN F KENNEDY BLVD
Mailing Address - Street 2:1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4126
Mailing Address - Country:US
Mailing Address - Phone:201-217-1224
Mailing Address - Fax:
Practice Address - Street 1:3523 JOHN F KENNEDY BLVD
Practice Address - Street 2:1
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-4126
Practice Address - Country:US
Practice Address - Phone:201-217-1224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC005875111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8658200Medicaid
NJ099283Medicare ID - Type Unspecified
NJ8658200Medicaid