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General NPI Number Information
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NPI Number | 1467640037
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN ACUPUNCTURE
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 579 BERGEN BLVD
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2032
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Country | US
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Telephone | 201-388-0535
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Fax |
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Provider Business Mailing Address
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Address Line | 409 JOHNED RD
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City | NORTHVALE
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State | NJ
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Zip | 07647-1111
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Country | US
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Telephone | 201-388-0535
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANNET MOLINA-MANTEIGA
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Credential |
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Telephone | 201-388-0535
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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 | 25MZ00067300
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License Number State | NJ
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