Provider Demographics
NPI:1497320733
Name:REIBAN KHANNA, PAULINA (DC)
Entity Type:Individual
Prefix:
First Name:PAULINA
Middle Name:
Last Name:REIBAN KHANNA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 RIVER RD APT 411
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6292
Mailing Address - Country:US
Mailing Address - Phone:201-367-8598
Mailing Address - Fax:
Practice Address - Street 1:21 S SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2624
Practice Address - Country:US
Practice Address - Phone:201-712-9113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012772111N00000X
NJ38MC00776700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor