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General NPI Number Information
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NPI Number | 1063780914
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Entity Type | Individual
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Provider Name | GERARD CORNELIUS REIDY JR. LAC, MSTOM , CA
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Gender | Male
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 111 QUIMBY ST
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City | WESTFIELD
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State | NJ
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Zip | 07090-2185
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Country | US
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Telephone | 908-612-5698
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Fax |
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Provider Business Mailing Address
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Address Line | 505 DOWNER ST
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City | WESTFIELD
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State | NJ
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Zip | 07090-4112
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Country | US
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Telephone | 908-612-5698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | MZ000203
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License Number State | NJ
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