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General NPI Number Information
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NPI Number | 1295622280
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Entity Type | Organization
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Legal Business Name | BLUE HERON VITALITY LLC
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Dates
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Enumeration Date | 06/21/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 333 FAIRVIEW AVE
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City | WESTWOOD
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State | NJ
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Zip | 07675-1704
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Country | US
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Telephone | 603-455-7146
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Fax |
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Provider Business Mailing Address
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Address Line | 369 KINDERKAMACK RD
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City | WESTWOOD
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State | NJ
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Zip | 07675-1652
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Country | US
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Telephone | 603-455-7146
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED ACUPUNCTURIST
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Name | RACHEL BURACK
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Credential | LAC
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Telephone | 603-455-7146
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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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