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General NPI Number Information
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NPI Number | 1083909303
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Entity Type | Organization
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Legal Business Name | BERGEN ACUPUNCTURE AND INTEGRATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 309A KINDERKAMACK ROAD
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City | WESTWOOD
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State | NJ
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Zip | 07675
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Country | US
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Telephone | 201-497-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 309A KINDERKAMACK ROAD
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City | WESTWOOD
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State | NJ
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Zip | 07675
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Country | US
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Telephone | 201-497-8118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JANNET MOLINA-MANTEIGA
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Credential | LCSW, LAC
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Telephone | 201-497-8118
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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 | 25MZ00040400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00580000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00067300
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License Number State | NJ
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