Healthcare Provider Details

I. General information

NPI: 1841662228
Provider Name (Legal Business Name): USA WILD GINSENG CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SYLVAN AVE STE 301
ENGLEWOOD CLIFFS NJ
07632-2724
US

IV. Provider business mailing address

333 SYLVAN AVE STE 301
ENGLEWOOD CLIFFS NJ
07632-2724
US

V. Phone/Fax

Practice location:
  • Phone: 201-446-6701
  • Fax: 201-567-5478
Mailing address:
  • Phone: 201-446-6701
  • Fax: 201-567-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00729500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00099200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00992600
License Number StateNJ

VIII. Authorized Official

Name: BRIAN KIM
Title or Position: BILLER
Credential:
Phone: 201-446-6701