Healthcare Provider Details

I. General information

NPI: 1740173038
Provider Name (Legal Business Name): JKP REGENERATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W CENTURY RD STE 300
PARAMUS NJ
07652-1435
US

IV. Provider business mailing address

30 W CENTURY RD STE 300
PARAMUS NJ
07652-1435
US

V. Phone/Fax

Practice location:
  • Phone: 516-775-8602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMALAN KRISHNAMOORTHY
Title or Position: OWNER
Credential:
Phone: 516-775-8602