Provider Demographics
NPI:1063837409
Name:BLISS WELLNESS EDISON CENTER
Entity Type:Organization
Organization Name:BLISS WELLNESS EDISON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNGMUN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-705-2232
Mailing Address - Street 1:2056A LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3373
Mailing Address - Country:US
Mailing Address - Phone:908-705-2232
Mailing Address - Fax:
Practice Address - Street 1:2056A LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3373
Practice Address - Country:US
Practice Address - Phone:908-705-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X
NJ25MZ00097300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty