Provider Demographics
NPI:1073238994
Name:EQUILIBRIUM ACUPUNCTURE OF MONTCLAIR LLC
Entity Type:Organization
Organization Name:EQUILIBRIUM ACUPUNCTURE OF MONTCLAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VAPHIDES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:973-873-0017
Mailing Address - Street 1:33 PLYMOUTH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2677
Mailing Address - Country:US
Mailing Address - Phone:973-873-0017
Mailing Address - Fax:
Practice Address - Street 1:33 PLYMOUTH ST STE 107
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2677
Practice Address - Country:US
Practice Address - Phone:973-873-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MZ00056900OtherLICENSED ACUPUNCTURIST