Healthcare Provider Details

I. General information

NPI: 1801178868
Provider Name (Legal Business Name): EUGENE OM BAEK L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18-01 POLLITT DR STE 3
FAIR LAWN NJ
07410-2816
US

IV. Provider business mailing address

18-01 POLLITT DR STE 3
FAIR LAWN NJ
07410-2816
US

V. Phone/Fax

Practice location:
  • Phone: 201-786-8060
  • Fax:
Mailing address:
  • Phone: 201-786-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00080600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: