Provider Demographics
NPI:1477547636
Name:PROODIAN, JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:PROODIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W END CT
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-5172
Mailing Address - Country:US
Mailing Address - Phone:732-222-2219
Mailing Address - Fax:732-229-8863
Practice Address - Street 1:10 W END CT
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5172
Practice Address - Country:US
Practice Address - Phone:732-222-2219
Practice Address - Fax:732-229-8863
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00452500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ383662747OtherTAX ID #
NJ071209RWLMedicare ID - Type Unspecified
NJ071209RWLMedicare PIN
NJU96054Medicare UPIN