MEDICARE: EAMONTCLAIR1

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

General Provider Information

NPI Number	:	1134884455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAMONTCLAIR1

Provider Business Mailing Address
First Line	:	50 CHURCH ST STE L10
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2745
Country	:	US
Telephone Number	:	973-509-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 CHURCH ST STE L10
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2745
Country	:	US
Telephone Number	:	973-509-8300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TALAH ROBBINS
Credential	:
Telephone Number	:	917-373-2357

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	02/22/2024

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Directions to “EAMONTCLAIR1 ” Practice Location

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