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General NPI Number Information
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NPI Number | 1073659587
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Entity Type | Organization
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Legal Business Name | RED OAK ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 17 HANOVER RD BLDG# 300
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1411
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Country | US
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Telephone | 201-400-2376
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Fax |
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Provider Business Mailing Address
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Address Line | 8 MOUNT PROSPECT AVE
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City | DOVER
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State | NJ
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Zip | 07801-3734
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Country | US
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Telephone | 201-400-2376
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATRINA L. HASKELL
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Credential | L.AC.
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Telephone | 201-400-2376
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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 | 25MZ00027800
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License Number State | NJ
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