Provider Demographics
NPI:1225870116
Name:PUREVERRA
Entity type:Organization
Organization Name:PUREVERRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHRAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-345-5686
Mailing Address - Street 1:700 PLAZA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3604
Mailing Address - Country:US
Mailing Address - Phone:201-345-5686
Mailing Address - Fax:
Practice Address - Street 1:1320 ADAMS ST STE DE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2370
Practice Address - Country:US
Practice Address - Phone:201-345-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty