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General NPI Number Information
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NPI Number | 1699593079
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Entity Type | Individual
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Provider Name | ALEXANDRA SACK L.AC.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 25-15 FAIR LAWN AVE STE 4
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City | FAIR LAWN
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State | NJ
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Zip | 07410-3434
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Country | US
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Telephone | 201-916-0509
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FRANKLIN AVE UNIT 507
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3279
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Country | US
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Telephone | 941-928-1500
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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 | 25MZ00173400
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License Number State | NJ
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