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NPI Code Detail

MEDICARE: PINE ACUPUNCTURE & HERBAL MEDICINE CLINIC

MEDICARE: PINE ACUPUNCTURE & HERBAL MEDICINE CLINIC
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
1302R00000XHealth Maintenance OrganizationMZ00016800NJ

General Provider Information

NPI Number : 1205160579
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINE ACUPUNCTURE & HERBAL MEDICINE CLINIC
Provider Business Mailing Address
First Line : 166 MAIN ST
Second Line : #2B
City : FORT LEE
State : NJ
Zip : 07024-6922
Country : US
Telephone Number : 201-585-8285
Fax Number :
Provider Business Practice Location Address
First Line : 166 MAIN ST
Second Line : #2B
City : FORT LEE
State : NJ
Zip : 07024-6922
Country : US
Telephone Number : 201-585-8285
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DOAM KIM
Credential :
Telephone Number : 201-585-8285
Provider Enumeration Date : 09/19/2009
Last Update Date : 09/19/2009

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Directions to “PINE ACUPUNCTURE & HERBAL MEDICINE CLINIC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.