Healthcare Provider Details

I. General information

NPI: 1497320733
Provider Name (Legal Business Name): PAULINA REIBAN KHANNA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S SPRING VALLEY RD
PARAMUS NJ
07652-2624
US

IV. Provider business mailing address

7912 RIVER RD APT 411
NORTH BERGEN NJ
07047-6292
US

V. Phone/Fax

Practice location:
  • Phone: 201-712-9113
  • Fax:
Mailing address:
  • Phone: 201-367-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX012772
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00776700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: