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Organization
INNOVATIVE SPINE CARE, LLC
Active
Organization
INNOVATIVE SPINE CARE, LLC
Active
Other names
Pure Anti Aging Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TATIANA SHARAHY M.D. (OWNER)
(201) 444-0020
Entity
Organization
Contact information
Practice address
18 W RIDGEWOOD AVE FL 2, PARAMUS, NJ 07652-2333
(201) 444-0020
(201) 444-0026
Mailing address
1144 E RIDGEWOOD AVE, RIDGEWOOD, NJ 07450-3915
(201) 444-0020
(201) 444-0026
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
25MA07099100
NJ
207R00000X
Internal Medicine Physician
25MA07099100
NJ
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
25MA07099100
NJ
Other
Enumeration date
03/19/2007
Last updated
04/12/2023
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