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General NPI Number Information
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NPI Number | 1669913729
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Entity Type | Organization
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Legal Business Name | ACUMERIDIAN WELLNESS LLC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 242 RTE 79 N SUITE 11
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City | MORGANVILLE
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State | NJ
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Zip | 07751-2078
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Country | US
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Telephone | 732-858-1322
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Fax | 855-755-7778
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Provider Business Mailing Address
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Address Line | 242 RTE 79 N SUITE 11
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City | MORGANVILLE
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State | NJ
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Zip | 07751-2078
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Country | US
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Telephone | 732-858-1322
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Fax | 855-755-7778
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE KOO
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Credential | DACM
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Telephone | 732-858-1322
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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 | 25MZ00102500
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License Number State | NJ
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