=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194205682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B. ACUPUNCTURE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2018
-----------------------------------------------------
Last Update Date | 07/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 N HADDON AVE STE 10
-----------------------------------------------------
City | HADDONFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08033-1753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-430-4113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 532 REVERE DR
-----------------------------------------------------
City | TURNERSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012-1253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-404-8693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED ACUPUNCTURIST
-----------------------------------------------------
Name | BRITTANY N HAUG
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 856-404-8693
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 25MZ00127300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------