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General NPI Number Information
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NPI Number | 1225852205
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Entity Type | Organization
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Legal Business Name | CLEAR MOUNTAIN ACUPUNCTURE LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 217 MONTCLAIR AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1706
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Country | US
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Telephone | 201-357-0535
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Fax | 212-223-0198
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Provider Business Mailing Address
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Address Line | 217 MONTCLAIR AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1706
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Country | US
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Telephone | 201-357-0535
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Fax | 212-223-0198
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELSEY TANGEL
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Credential |
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Telephone | 201-357-0535
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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 |
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License Number State |
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