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General NPI Number Information
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NPI Number | 1588059125
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Entity Type | Organization
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Legal Business Name | BAMBOO WELLNESS, LLC
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 170 HWY 35
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City | RED BANK
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State | NJ
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Zip | 07701-5929
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Country | US
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Telephone | 732-741-5772
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Fax | 732-741-5778
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Provider Business Mailing Address
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Address Line | 170 HWY 35
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City | RED BANK
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State | NJ
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Zip | 07701-5929
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Country | US
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Telephone | 732-741-5772
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Fax | 732-741-5778
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Authorized Official
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Title or Position | ACUPUNCTURIST/OWNER
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Name | DR. MARLENA SZITANKO
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Credential | DIPL. AC., LAC.
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Telephone | 732-741-5772
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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 | 25 MZ00076600
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License Number State | NJ
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