Provider Demographics
NPI:1093103426
Name:EASTERN CURRENTS ACUPUNCTURE PC
Entity Type:Organization
Organization Name:EASTERN CURRENTS ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JAESUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-210-9553
Mailing Address - Street 1:2330 LINWOOD AVE
Mailing Address - Street 2:APT 4F
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3862
Mailing Address - Country:US
Mailing Address - Phone:201-210-9553
Mailing Address - Fax:
Practice Address - Street 1:8 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2316
Practice Address - Country:US
Practice Address - Phone:516-308-9119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005222-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty