Healthcare Provider Details

I. General information

NPI: 1225388655
Provider Name (Legal Business Name): WELLNESS ACUPUNCTURE STUDIO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 LIBERTY ST
LITTLE FERRY NJ
07643-1858
US

IV. Provider business mailing address

159 LIBERTY ST
LITTLE FERRY NJ
07643-1858
US

V. Phone/Fax

Practice location:
  • Phone: 201-388-7339
  • Fax:
Mailing address:
  • Phone: 201-388-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE MASANGKAY
Title or Position: CEO, PRESIDENT
Credential: L.AC.
Phone: 201-388-7339