Provider Demographics
NPI:1083909303
Name:BERGEN ACUPUNCTURE AND INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:BERGEN ACUPUNCTURE AND INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANNET
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA-MANTEIGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:201-497-8118
Mailing Address - Street 1:309A KINDERKAMACK ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-497-8118
Mailing Address - Fax:
Practice Address - Street 1:309A KINDERKAMACK ROAD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-497-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00580000111N00000X
NJ25MZ00067300171100000X
NJ25MZ00040400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty