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General NPI Number Information
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NPI Number | 1679383343
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Entity Type | Organization
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Legal Business Name | CORAL DRAGON ACUPUNCTURE
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 366 PASSAIC AVE
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City | NUTLEY
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State | NJ
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Zip | 07110-2737
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Country | US
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Telephone | 862-926-9578
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Fax |
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Provider Business Mailing Address
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Address Line | 21 ASHWOOD TER
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City | WEST ORANGE
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State | NJ
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Zip | 07052-5901
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Country | US
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Telephone | 862-202-6859
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. DENISE MERCEDES LONG
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Credential |
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Telephone | 862-202-6859
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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 |
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License Number State |
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