Healthcare Provider Details

I. General information

NPI: 1194404707
Provider Name (Legal Business Name): SMART ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 WASHINGTON AVE STE 2B
NUTLEY NJ
07110-1995
US

IV. Provider business mailing address

1570 ANDERSON AVE APT B
FORT LEE NJ
07024-2713
US

V. Phone/Fax

Practice location:
  • Phone: 973-661-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RISHENG MA
Title or Position: MANAGER
Credential:
Phone: 347-366-1084