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General NPI Number Information
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NPI Number | 1336284652
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Entity Type | Individual
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Provider Name | KATALIN GORDON LAC
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 605 VALLEY ROAD
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City | MONTCLAIR
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State | NJ
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Zip | 07043
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Country | US
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Telephone | 973-677-3758
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Fax |
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Provider Business Mailing Address
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Address Line | 211 PARK PLACE
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City | ORANGE
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State | NJ
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Zip | 07050-4103
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Country | US
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Telephone | 973-677-3758
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 25MZ00011500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 001059
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License Number State | NY
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