Healthcare Provider Details

I. General information

NPI: 1396564571
Provider Name (Legal Business Name): TORI OLSEN L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BROAD ST # 101
RED BANK NJ
07701-2009
US

IV. Provider business mailing address

1804 A ST
BELMAR NJ
07719-2622
US

V. Phone/Fax

Practice location:
  • Phone: 732-995-2530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00173600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: