Healthcare Provider Details

I. General information

NPI: 1912270851
Provider Name (Legal Business Name): DANA ACUPUNCTURE PAIN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 CENTER AVENUE SUITE # O
FORT LEE NJ
07024
US

IV. Provider business mailing address

2024 CENTER AVENUE SUITE # O
FORT LEE NJ
07024
US

V. Phone/Fax

Practice location:
  • Phone: 201-585-9338
  • Fax: 201-585-9337
Mailing address:
  • Phone: 201-585-9338
  • Fax: 201-585-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00075000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01398200
License Number StateNJ

VIII. Authorized Official

Name: JAY CHUN
Title or Position: MANAGER
Credential:
Phone: 201-585-9338