Healthcare Provider Details

I. General information

NPI: 1992261028
Provider Name (Legal Business Name): REN ACUPUNCTURE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S 17TH ST UNIT 1
EASTON PA
18042-3927
US

IV. Provider business mailing address

150 S 17TH ST UNIT 1
EASTON PA
18042-3927
US

V. Phone/Fax

Practice location:
  • Phone: 484-591-8637
  • Fax:
Mailing address:
  • Phone: 484-591-8637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LIJIA REN
Title or Position: PHYSICAL THERPIST
Credential:
Phone: 484-591-8637