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General NPI Number Information
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NPI Number | 1376141077
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Entity Type | Organization
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Legal Business Name | PRIME ACUPUNCTURE CLINIC, LLC
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 71 GRAND AVE STE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3531
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Country | US
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Telephone | 201-408-5181
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Fax |
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Provider Business Mailing Address
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Address Line | 85 WASHINGTON AVE
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010-3026
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Country | US
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Telephone | 201-407-4411
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | SOOJIN YEOM
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Credential | L.AC.
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Telephone | 201-408-5181
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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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