Healthcare Provider Details

I. General information

NPI: 1013776087
Provider Name (Legal Business Name): MONTVALE ACUPUNCTURE AND PAIN CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 CHESTNUT RIDGE RD STE 250
MONTVALE NJ
07645-1152
US

IV. Provider business mailing address

135 CHESTNUT RIDGE RD STE 250
MONTVALE NJ
07645-1152
US

V. Phone/Fax

Practice location:
  • Phone: 201-270-0900
  • Fax: 201-502-0654
Mailing address:
  • Phone: 201-270-0900
  • Fax: 201-502-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JIN HO LEE
Title or Position: OWNER
Credential: L.AC.
Phone: 201-543-3667