# INNOVATIVE SPINE CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pure Anti Aging Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952425621
- **Authorized official:** DR. TATIANA SHARAHY M.D. (OWNER)
- **Authorized official phone:** (201) 444-0020

## Contact information

- **Practice address:** 18 W RIDGEWOOD AVE FL 2, PARAMUS, NJ 07652-2333
- **Practice address phone:** (201) 444-0020
- **Practice address fax:** (201) 444-0026
- **Mailing address:** 1144 E RIDGEWOOD AVE, RIDGEWOOD, NJ 07450-3915
- **Mailing address phone:** (201) 444-0020
- **Mailing address fax:** (201) 444-0026

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | 25MA07099100 | NJ | — |
| 207R00000X | Internal Medicine Physician | 25MA07099100 | NJ | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 25MA07099100 | NJ | Yes |

## Other

- **Enumeration date:** 03/19/2007
- **Last updated:** 04/12/2023