MEDICARE: PINK LOTUS, LLC

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

General Provider Information

NPI Number	:	1780148767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINK LOTUS, LLC

Provider Business Mailing Address
First Line	:	1325 WARREN AVE STE 6
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2567
Country	:	US
Telephone Number	:	732-547-8281
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 WARREN AVE STE 6
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2567
Country	:	US
Telephone Number	:	732-547-8281
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RACHEL TAILLACQ
Credential	:	LAC
Telephone Number	:	732-547-8281

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/24/2019

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Directions to “PINK LOTUS, LLC ” Practice Location

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