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General NPI Number Information
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NPI Number | 1659742344
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Entity Type | Individual
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Provider Name | ALICE PAN
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Gender | Female
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 27 WITHERSPOON ST
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City | PRINCETON
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State | NJ
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Zip | 08542-3237
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Country | US
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Telephone | 609-902-9305
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Fax |
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Provider Business Mailing Address
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Address Line | 18 PROVIDENCE DR
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City | PRINCETON JCT
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State | NJ
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Zip | 08550-2152
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Country | US
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Telephone | 609-902-9305
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 023103
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License Number State | NY
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