MEDICARE: SANGROK MOON D.C., 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	111N00000X	Chiropractor	38MC00648800	NJ
2	171100000X	Acupuncturist	25MZ00081300	NJ

General Provider Information

NPI Number	:	1184988107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANGROK MOON D.C., L.AC.

Provider Business Mailing Address
First Line	:	2460 LEMOINE AVE STE 203
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6210
Country	:	US
Telephone Number	:	201-559-5307
Fax Number	:	201-351-4787

Provider Business Practice Location Address
First Line	:	2460 LEMOINE AVE STE 203
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6210
Country	:	US
Telephone Number	:	201-559-5307
Fax Number	:	201-351-4787

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

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	12/09/2020

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Directions to “ SANGROK MOON D.C., L.AC.” Practice Location

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