Provider Demographics
NPI:1083083828
Name:NEWARK ACUPUCNTURE WELLNESS PC
Entity Type:Organization
Organization Name:NEWARK ACUPUCNTURE WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNGMUN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-937-1551
Mailing Address - Street 1:60 PARK PL STE 402
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-5513
Mailing Address - Country:US
Mailing Address - Phone:201-937-1551
Mailing Address - Fax:646-478-9778
Practice Address - Street 1:60 PARK PL STE 402
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-5513
Practice Address - Country:US
Practice Address - Phone:201-937-1551
Practice Address - Fax:646-478-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00097300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty