Provider Demographics
NPI:1962412908
Name:SAHOURY, ROGER D (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:SAHOURY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4038
Mailing Address - Country:US
Mailing Address - Phone:201-265-0555
Mailing Address - Fax:201-265-5559
Practice Address - Street 1:156 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1422
Practice Address - Country:US
Practice Address - Phone:201-444-2809
Practice Address - Fax:201-444-2819
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00617300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081099S8EMedicare ID - Type Unspecified