Healthcare Provider Details

I. General information

NPI: 1891118451
Provider Name (Legal Business Name): NJ ADVANCED ACUPUNCTURE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 07/11/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MALLARD LN
LAVALLETTE NJ
08735-1615
US

IV. Provider business mailing address

101 MARKETSIDE AVE STE 404 PMB 327
PONTE VEDRA FL
32081
US

V. Phone/Fax

Practice location:
  • Phone: 201-400-2261
  • Fax:
Mailing address:
  • Phone: 201-400-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2953
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00058400
License Number StateNJ

VIII. Authorized Official

Name: MORGAN READE
Title or Position: OWNER
Credential: AP., L.A.C.
Phone: 201-400-2261