Healthcare Provider Details

I. General information

NPI: 1205281490
Provider Name (Legal Business Name): RIDGEWOOD ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SENECA AVE
RIDGEWOOD NY
11385-2170
US

IV. Provider business mailing address

2500 LEMOINE AVE FL 3
FORT LEE NJ
07024-6232
US

V. Phone/Fax

Practice location:
  • Phone: 201-363-0233
  • Fax:
Mailing address:
  • Phone: 201-363-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0016571
License Number StateNY

VIII. Authorized Official

Name: JI KIM
Title or Position: ACUPUNCTURIST
Credential:
Phone: 718-497-9760