MEDICARE: VINCENT JAE HYEONG HA 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	25MZ00106000	NJ
2	171100000X	Acupuncturist	005009	NY

General Provider Information

NPI Number	:	1508291006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT JAE HYEONG HA L.AC

Provider Business Mailing Address
First Line	:	2147 HUDSON TER STE 2
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-7732
Country	:	US
Telephone Number	:	201-257-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2147 HUDSON TER STE 2
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-7732
Country	:	US
Telephone Number	:	201-257-3020
Fax Number	:

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

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	10/05/2023

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