Provider Demographics
NPI:1194178749
Name:SPARK ACUPUNCTURE ASSOCIATES LLC
Entity Type:Organization
Organization Name:SPARK ACUPUNCTURE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNG HO
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:201-970-6174
Mailing Address - Street 1:688 WESTWOOD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6375
Mailing Address - Country:US
Mailing Address - Phone:201-596-4040
Mailing Address - Fax:201-648-7905
Practice Address - Street 1:688 WESTWOOD AVE STE 2
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6375
Practice Address - Country:US
Practice Address - Phone:201-596-4040
Practice Address - Fax:201-648-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00072700171100000X
NJ171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty