Provider Demographics
NPI:1184022592
Name:JERSEYJIVA LLC
Entity type:Organization
Organization Name:JERSEYJIVA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HRANICHNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-455-8810
Mailing Address - Street 1:171 NEWARK AVE
Mailing Address - Street 2:JIVAMUKTI YOGA 2ND FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2813
Mailing Address - Country:US
Mailing Address - Phone:917-455-8810
Mailing Address - Fax:
Practice Address - Street 1:171 NEWARK AVE
Practice Address - Street 2:JIVAMUKTI YOGA 2ND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2813
Practice Address - Country:US
Practice Address - Phone:917-455-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty