Healthcare Provider Details

I. General information

NPI: 1205756574
Provider Name (Legal Business Name): ELIZABETH B KATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 NEWCOMB RD
RIDGEWOOD NJ
07450-5520
US

IV. Provider business mailing address

727 NEWCOMB RD
RIDGEWOOD NJ
07450-5520
US

V. Phone/Fax

Practice location:
  • Phone: 201-739-5761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00183800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: