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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