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General NPI Number Information
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NPI Number | 1588165922
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Entity Type | Organization
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Legal Business Name | TO AN ORIGIN PC
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 25 LINDSLEY DR STE 202
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City | MORRISTOWN
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State | NJ
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Zip | 07960-4456
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Country | US
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Telephone | 862-701-2037
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Fax |
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Provider Business Mailing Address
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Address Line | 38 SUNRISE DR
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City | WHIPPANY
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State | NJ
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Zip | 07981-1103
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Country | US
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Telephone | 862-701-2037
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MS. WEIYA FANG
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Credential | LAC.
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Telephone | 862-701-2037
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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 | 25MZ00122900
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License Number State | NJ
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