Provider Demographics
NPI:1356090419
Name:ACUPUNCTURE HEALTH AND WELLNESS PC
Entity Type:Organization
Organization Name:ACUPUNCTURE HEALTH AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODIK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSAC
Authorized Official - Phone:201-880-6207
Mailing Address - Street 1:9-09 ELAINE TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5714
Mailing Address - Country:US
Mailing Address - Phone:201-880-6207
Mailing Address - Fax:
Practice Address - Street 1:16-00 ROUTE 208 STE 204
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2506
Practice Address - Country:US
Practice Address - Phone:201-880-6207
Practice Address - Fax:201-880-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty