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General NPI Number Information
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NPI Number | 1174989719
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Entity Type | Organization
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Legal Business Name | BE WELL ORIENTAL MEDICINE
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 841 KEARNY AVE APT 1
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City | KEARNY
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State | NJ
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Zip | 07032-3249
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Country | US
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Telephone | 201-913-3977
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Fax | 888-534-5993
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Provider Business Mailing Address
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Address Line | 8200 BOULEVARD E APT 28L
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City | NORTH BERGEN
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State | NJ
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Zip | 07047-6045
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Country | US
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Telephone | 201-913-3977
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Fax | 888-534-5993
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Authorized Official
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Title or Position | OWNER
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Name | MYONG OK OM
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Credential | LAC
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Telephone | 201-913-3977
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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 | 25MZ00107700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 005008
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License Number State | NY
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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 | 005016
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00099600
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License Number State | NJ
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