Provider Demographics
NPI: | 1174199525 |
---|---|
Name: | CROSSING HEALTH ACUPUNCTURE |
Entity Type: | Organization |
Organization Name: | CROSSING HEALTH ACUPUNCTURE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | GABRIELA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CAMACHO-VASCONEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 484-536-9197 |
Mailing Address - Street 1: | 101 S 3RD ST STE 203 |
Mailing Address - Street 2: | |
Mailing Address - City: | EASTON |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 18042-4524 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 484-536-9197 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 101 S 3RD ST STE 203 |
Practice Address - Street 2: | |
Practice Address - City: | EASTON |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18042-4524 |
Practice Address - Country: | US |
Practice Address - Phone: | 484-536-9197 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-05-27 |
Last Update Date: | 2023-06-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171100000X | Other Service Providers | Acupuncturist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 000000 | Other | N/A |
NA | Other | N/A |