Provider Demographics
NPI:1154823565
Name:NEW SEASON HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:NEW SEASON HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNGHWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-808-1423
Mailing Address - Street 1:12 SNOWHILL ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 SNOWHILL ST STE 3
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884
Practice Address - Country:US
Practice Address - Phone:626-808-1423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00732100111N00000X
NJ25MZ00117500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty