Provider Demographics
NPI:1013361328
Name:ESSENTIA ACUPUNCTURE
Entity Type:Organization
Organization Name:ESSENTIA ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MENAKSHI
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MSTOM
Authorized Official - Phone:949-584-0659
Mailing Address - Street 1:1144 BRIANS WAY
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:605 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3108
Practice Address - Country:US
Practice Address - Phone:949-584-0659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM00141302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization