=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669875506
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA BARBARA L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2014
-----------------------------------------------------
Last Update Date | 02/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 268 US HIGHWAY 206 STE 406
-----------------------------------------------------
City | FLANDERS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07836-9083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-668-5500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 268 US HIGHWAY 206 STE 406
-----------------------------------------------------
City | FLANDERS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07836-9083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-668-5500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 005417
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------