Healthcare Provider Details

I. General information

NPI: 1518231869
Provider Name (Legal Business Name): GOLDEN FLOWER ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 KINGFISHER CT
MARLBORO NJ
07746-2504
US

IV. Provider business mailing address

PO BOX 487
MORGANVILLE NJ
07751-0487
US

V. Phone/Fax

Practice location:
  • Phone: 732-740-7709
  • Fax: 732-677-3636
Mailing address:
  • Phone: 732-740-7709
  • Fax: 732-677-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00079700
License Number StateNJ

VIII. Authorized Official

Name: IRINA ROYTMAN
Title or Position: MANAGER
Credential: L.AC
Phone: 732-740-7709