=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558878330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NJ ACUPUNCTURE AND HERBOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2018
-----------------------------------------------------
Last Update Date | 01/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 ROCHELLE AVE STE 202
-----------------------------------------------------
City | ROCHELLE PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07662-3341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-448-5661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 ROCHELLE AVE STE 202
-----------------------------------------------------
City | ROCHELLE PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07662-3341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RACHEL LOPEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-448-5661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 25MZ00128700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------