MEDICARE: PROF. JENNIFER J SUN L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	25MZ00071300	NJ

General Provider Information

NPI Number	:	1154650356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. JENNIFER J SUN L.AC

Provider Business Mailing Address
First Line	:	190 STATE ROUTE 18 N STE 200
Second Line	:	TURNPIKE METROPLEX
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1407
Country	:	US
Telephone Number	:	732-822-9801
Fax Number	:	732-509-9196

Provider Business Practice Location Address
First Line	:	190 STATE ROUTE 18 N STE 200
Second Line	:	190 STATE ROUTE 18N, SUITE 200
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1407
Country	:	US
Telephone Number	:	732-822-9801
Fax Number	:	732-509-9196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	05/12/2016

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