Provider Demographics
NPI:1730626706
Name:SANTHIGRAM KERALA AYURVEDIC CO OF US INC
Entity type:Organization
Organization Name:SANTHIGRAM KERALA AYURVEDIC CO OF US INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GOPINATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-915-8813
Mailing Address - Street 1:1503 FINNEGAN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1061
Mailing Address - Country:US
Mailing Address - Phone:732-658-6070
Mailing Address - Fax:
Practice Address - Street 1:1503 FINNEGAN LN
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1061
Practice Address - Country:US
Practice Address - Phone:732-658-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400444925261QM1300X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty