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General NPI Number Information
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NPI Number | 1891117891
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Entity Type | Organization
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Legal Business Name | VBACUPUNCTURE
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 265 STATE ROUTE 34
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City | COLTS NECK
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State | NJ
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Zip | 07722-2435
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Country | US
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Telephone | 732-858-1548
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Fax |
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Provider Business Mailing Address
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Address Line | 254 DAFFODIL DR
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City | FREEHOLD
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State | NJ
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Zip | 07728-4071
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Country | US
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Telephone | 732-858-1548
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST AND HERBALIST
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Name | MS. VERONICA BOGOMAZOVA
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Credential | L.AC
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Telephone | 908-338-1077
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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 | 25MZ00101400
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License Number State | NJ
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