MEDICARE: MS. ERIN GRANT CA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist
2	171100000X	Acupuncturist	MZ000103	NJ

General Provider Information

NPI Number	:	1124079322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN GRANT CA

Provider Business Mailing Address
First Line	:	205 NARRAGANSETTE AVE # 536
Second Line	:
City	:	OCEAN GATE
State	:	NJ
Zip	:	08740-1365
Country	:	US
Telephone Number	:	732-600-7467
Fax Number	:	609-693-4480

Provider Business Practice Location Address
First Line	:	769 ROUTE 9 STE 6
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-2540
Country	:	US
Telephone Number	:	732-600-7467
Fax Number	:	732-269-9630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/26/2020

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