Provider Demographics
NPI:1821234626
Name:ALIREZA A. FOROUSHANI, PC
Entity Type:Organization
Organization Name:ALIREZA A. FOROUSHANI, PC
Other - Org Name:WYCKOFF FAMILY CHIROPRACTIC & SPINAL HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:ABTAHI
Authorized Official - Last Name:FOROUSHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-485-7518
Mailing Address - Street 1:260 GODWIN AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-5200
Mailing Address - Country:US
Mailing Address - Phone:201-485-7518
Mailing Address - Fax:201-485-7517
Practice Address - Street 1:260 GODWIN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-5200
Practice Address - Country:US
Practice Address - Phone:201-485-7518
Practice Address - Fax:201-485-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00658900261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ116632W5YMedicare UPIN