Healthcare Provider Details

I. General information

NPI: 1134218019
Provider Name (Legal Business Name): IRINA ROYTMAN L. AC., DIPL. OM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 MORRIS AVE
ELIZABETH NJ
07208-3609
US

IV. Provider business mailing address

25 KILMER DR BUILDING #3, STE.215
MORGANVILLE NJ
07751-1564
US

V. Phone/Fax

Practice location:
  • Phone: 732-740-7709
  • Fax: 732-677-3636
Mailing address:
  • Phone: 732-740-7709
  • Fax: 732-677-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25 MZ00038500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: