Provider Demographics
NPI:1356412688
Name:AQUIL, ELAINE ASYAH (DC)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:ASYAH
Last Name:AQUIL
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 1:73 FERRY ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1831
Mailing Address - Country:US
Mailing Address - Phone:973-466-9828
Mailing Address - Fax:973-466-9829
Practice Address - Street 1:73 FERRY ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1831
Practice Address - Country:US
Practice Address - Phone:973-466-9828
Practice Address - Fax:973-466-9829
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ03686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3432505Medicaid
NJ3432505Medicaid