Provider Demographics
NPI:1609943026
Name:ABOVE AND BEYOND HOLISTIC WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ABOVE AND BEYOND HOLISTIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-444-2809
Mailing Address - Street 1:122 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4038
Mailing Address - Country:US
Mailing Address - Phone:201-265-0555
Mailing Address - Fax:
Practice Address - Street 1:156 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1422
Practice Address - Country:US
Practice Address - Phone:201-444-2809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00617300111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083851Medicare PIN