=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801345012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEANNA CARELL ACUPUNCTURE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2016
-----------------------------------------------------
Last Update Date | 09/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 BEECH ST
-----------------------------------------------------
City | NUTLEY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07110-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-247-4388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 BEECH ST
-----------------------------------------------------
City | NUTLEY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07110-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-247-4388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DEANNA J CARELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-247-4388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 25MZ00118000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------