Provider Demographics
NPI:1184666950
Name:BEAN, JUSTIN A (CA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:A
Last Name:BEAN
Suffix:
Gender:M
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1872
Mailing Address - Country:US
Mailing Address - Phone:609-926-3766
Mailing Address - Fax:609-653-1042
Practice Address - Street 1:16 W NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1872
Practice Address - Country:US
Practice Address - Phone:609-926-3766
Practice Address - Fax:609-653-1042
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMZ000111171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist