=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295543601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRISTINE HEALTH ACUPUNCTURE AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2024
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 CLINTON PL APT 404
-----------------------------------------------------
City | HACKENSACK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07601-4664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-669-8823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 CLINTON PL APT 404
-----------------------------------------------------
City | HACKENSACK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07601-4664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-669-8823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | CHRISTINE YUN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-669-8823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------