Healthcare Provider Details

I. General information

NPI: 1427582709
Provider Name (Legal Business Name): SUMMIT ACUPUNCTURE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 BLOOMFIELD AVE
WEST CALDWELL NJ
07006
US

IV. Provider business mailing address

PO BOX 42
ROSELAND NJ
07068-0042
US

V. Phone/Fax

Practice location:
  • Phone: 973-227-7277
  • Fax:
Mailing address:
  • Phone: 973-227-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00176500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00024400
License Number StateNJ

VIII. Authorized Official

Name: AMY GONZALEZ
Title or Position: FOUNDER
Credential:
Phone: 973-227-7277