Healthcare Provider Details

I. General information

NPI: 1134884455
Provider Name (Legal Business Name): EAMONTCLAIR1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CHURCH ST STE L10
MONTCLAIR NJ
07042-2745
US

IV. Provider business mailing address

50 CHURCH ST STE L10
MONTCLAIR NJ
07042-2745
US

V. Phone/Fax

Practice location:
  • Phone: 973-509-8300
  • Fax:
Mailing address:
  • Phone: 973-509-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TALAH ROBBINS
Title or Position: OWNER
Credential:
Phone: 917-373-2357