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General NPI Number Information
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NPI Number | 1699026625
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Entity Type | Organization
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Legal Business Name | ATLANTIC ACUPUNCTURE & ORIENTAL MEDICAL CENTER
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 721 RIDGEWOOD AVE #9
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City | HOLLY HILL
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State | FL
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Zip | 32117-3646
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Country | US
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Telephone | 386-947-9009
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Fax | 386-947-9232
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Provider Business Mailing Address
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Address Line | 721 RIDGEWOOD AVE #9
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City | HOLLY HILL
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State | FL
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Zip | 32117-3646
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Country | US
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Telephone | 386-947-9009
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Fax | 386-947-9232
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MR. JONATHAN MARK COHEN
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Credential | A.P.
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Telephone | 386-947-9009
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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 | AP 1615
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License Number State | FL
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