Healthcare Provider Details

I. General information

NPI: 1073238994
Provider Name (Legal Business Name): EQUILIBRIUM ACUPUNCTURE OF MONTCLAIR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 PLYMOUTH ST STE 107
MONTCLAIR NJ
07042-2677
US

IV. Provider business mailing address

33 PLYMOUTH ST STE 107
MONTCLAIR NJ
07042-2677
US

V. Phone/Fax

Practice location:
  • Phone: 973-873-0017
  • Fax:
Mailing address:
  • Phone: 973-873-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH VAPHIDES
Title or Position: OWNER
Credential: LAC
Phone: 973-873-0017