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General NPI Number Information
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NPI Number | 1427405448
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Entity Type | Organization
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Legal Business Name | LONGEVITY ACUPUNCTURE
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 25 ROCKWOOD PL SUITE# 110
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4957
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Country | US
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Telephone | 201-982-1983
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HILLCREST RD
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City | TENAFLY
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State | NJ
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Zip | 07670-1414
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Country | US
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Telephone | 201-982-1983
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. PEMA YANG CHEN
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Credential | LAC.
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Telephone | 201-982-1983
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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 | 005237
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License Number State | NY
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