Healthcare Provider Details

I. General information

NPI: 1669722591
Provider Name (Legal Business Name): OPTIMUM HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 WASHINGTON ST FL 2
HOBOKEN NJ
07030-5517
US

IV. Provider business mailing address

1321 WASHINGTON ST FL 2
HOBOKEN NJ
07030-5517
US

V. Phone/Fax

Practice location:
  • Phone: 347-686-4787
  • Fax:
Mailing address:
  • Phone: 347-686-4787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00082700
License Number StateNJ

VIII. Authorized Official

Name: OPTIMUM HEALING
Title or Position: OWNER
Credential:
Phone: 347-686-4787