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General NPI Number Information
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NPI Number | 1922426550
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Entity Type | Organization
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Legal Business Name | BLUEREN HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 11/20/2016
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Provider Practice Location Address
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Address Line | 282 MAIN ST SUITE 1
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City | LODI
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State | NJ
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Zip | 07644-1829
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Country | US
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Telephone | 973-346-2616
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Fax | 732-374-4090
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Provider Business Mailing Address
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Address Line | 282 MAIN ST SUITE 1
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City | LODI
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State | NJ
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Zip | 07644-1829
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Country | US
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Telephone | 973-346-2616
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Fax | 732-374-4090
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Authorized Official
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Title or Position | OWNER
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Name | FATMA MINHAS-KUCUK
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Credential |
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Telephone | 973-346-2616
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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 | 25MZ00107300
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License Number State | NJ
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