Healthcare Provider Details

I. General information

NPI: 1174366454
Provider Name (Legal Business Name): HERBA ACUPUNCTURE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FOX HOLLOW LN
BRISTOL CT
06010-8965
US

IV. Provider business mailing address

220 FOX HOLLOW LN
BRISTOL CT
06010-8965
US

V. Phone/Fax

Practice location:
  • Phone: 860-329-1261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number State

VIII. Authorized Official

Name: EUGENIUSZ ZAGAJA
Title or Position: OWNER
Credential:
Phone: 860-329-1261