=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184139909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NARGES SARRAFAN DACM, L.AC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2017
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 S FRANKLIN TPKE
-----------------------------------------------------
City | RAMSEY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07446-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-962-7633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 356 POCONO CT
-----------------------------------------------------
City | MAHWAH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07430-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 006072
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 25MZ00128900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------