Healthcare Provider Details

I. General information

NPI: 1790465466
Provider Name (Legal Business Name): NEW BETHESDA ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 STONEWALL RD
SADDLE RIVER NJ
07458-2952
US

IV. Provider business mailing address

5 STONEWALL RD
SADDLE RIVER NJ
07458-2952
US

V. Phone/Fax

Practice location:
  • Phone: 917-882-1781
  • Fax: 201-236-5989
Mailing address:
  • Phone: 917-882-1781
  • Fax: 201-236-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MINGZHI YANG
Title or Position: ACUPUNCTRIST
Credential:
Phone: 917-882-1781