Healthcare Provider Details

I. General information

NPI: 1689286007
Provider Name (Legal Business Name): KOAM ACUPUNCTURE & HERBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 AVENUE C
BAYONNE NJ
07002-3012
US

IV. Provider business mailing address

300 WINSTON DR APT 615
CLIFFSIDE PARK NJ
07010-3213
US

V. Phone/Fax

Practice location:
  • Phone: 201-913-3977
  • Fax: 888-534-5993
Mailing address:
  • Phone: 201-913-3977
  • Fax: 888-534-5993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: NOMI OM
Title or Position: MANAGER
Credential:
Phone: 201-913-3977