Provider Demographics
NPI:1326455080
Name:JENNIFER LAYNE ACUPUNCTURE AND WELLNESS LLC
Entity Type:Organization
Organization Name:JENNIFER LAYNE ACUPUNCTURE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST- OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-687-7350
Mailing Address - Street 1:54 AMES AVE.
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070
Mailing Address - Country:US
Mailing Address - Phone:201-687-7350
Mailing Address - Fax:201-636-2615
Practice Address - Street 1:54 AMES AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1702
Practice Address - Country:US
Practice Address - Phone:201-687-7350
Practice Address - Fax:201-636-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00084300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty