Healthcare Provider Details

I. General information

NPI: 1275975476
Provider Name (Legal Business Name): RAYMOND J AHLES L.AC/ DIPL.OM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 S WASHINGTON AVE
BERGENFIELD NJ
07621-2324
US

IV. Provider business mailing address

53 S WASHINGTON AVE
BERGENFIELD NJ
07621-2324
US

V. Phone/Fax

Practice location:
  • Phone: 201-385-3130
  • Fax: 201-385-9688
Mailing address:
  • Phone: 201-385-3130
  • Fax: 201-385-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberMZ00016600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: