MEDICARE: ACUPUNCTURE EDEN

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	25MZ00099700	NJ

General Provider Information

NPI Number	:	1780059766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUPUNCTURE EDEN

Provider Business Mailing Address
First Line	:	630 SPRINGFIELD AVE
Second Line	:	SUITE 1
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1008
Country	:	US
Telephone Number	:	908-370-4233
Fax Number	:	908-888-0236

Provider Business Practice Location Address
First Line	:	630 SPRINGFIELD AVE
Second Line	:	SUITE 1
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1008
Country	:	US
Telephone Number	:	908-370-4233
Fax Number	:	908-888-0236

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	BRET KOTTLER
Credential	:	L.AC.
Telephone Number	:	908-370-4233

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	12/02/2015

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Directions to “ACUPUNCTURE EDEN ” Practice Location

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