MEDICARE: SMART ACUPUNCTURE PC

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	:	1194404707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART ACUPUNCTURE PC

Provider Business Mailing Address
First Line	:	1570 ANDERSON AVE APT B
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	187 WASHINGTON AVE STE 2B
Second Line	:
City	:	NUTLEY
State	:	NJ
Zip	:	07110-1995
Country	:	US
Telephone Number	:	973-661-0500
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RISHENG MA
Credential	:
Telephone Number	:	347-366-1084

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	07/12/2023

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