Healthcare Provider Details

I. General information

NPI: 1639935117
Provider Name (Legal Business Name): YC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 ANDERSON AVE
FORT LEE NJ
07024-2748
US

IV. Provider business mailing address

1625 ANDERSON AVE
FORT LEE NJ
07024-2748
US

V. Phone/Fax

Practice location:
  • Phone: 201-655-4500
  • 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 Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: YEONG C KIM
Title or Position: PROVIDER
Credential:
Phone: 201-655-4500