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General NPI Number Information
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NPI Number | 1659781599
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Entity Type | Individual
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Provider Name | VERONICA BOGOMAZOVA L.AC
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Gender | Female
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 740 NJ-34 2ND FLOOR, SUITE E
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City | MATAWAN
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State | NJ
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Zip | 07747-6688
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Country | US
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Telephone | 732-540-7233
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Fax |
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Provider Business Mailing Address
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Address Line | 72 MANOR DRIVE
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City | RED BANK
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State | NJ
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Zip | 07701
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Country | US
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Telephone | 908-338-1077
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00101400
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License Number State | NJ
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