Healthcare Provider Details

I. General information

NPI: 1588796544
Provider Name (Legal Business Name): AAYUSH HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CENTRAL AVE
NEWARK NJ
07107-1466
US

IV. Provider business mailing address

507 CENTRAL AVE
NEWARK NJ
07107-1466
US

V. Phone/Fax

Practice location:
  • Phone: 973-482-9300
  • Fax: 973-482-9322
Mailing address:
  • Phone: 973-482-9300
  • Fax: 973-482-9322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00711300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SIVA TALLAVAJHALA
Title or Position: MR.
Credential: B.PHARM, MS
Phone: 732-423-1166