Provider Demographics
NPI:1407123029
Name:RIVER DELL ACUPUNCTURE WELLNESS PC
Entity Type:Organization
Organization Name:RIVER DELL ACUPUNCTURE WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:XIA
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:201-993-6115
Mailing Address - Street 1:56 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2402
Mailing Address - Country:US
Mailing Address - Phone:201-993-6115
Mailing Address - Fax:201-483-6295
Practice Address - Street 1:56 GATES AVE
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2402
Practice Address - Country:US
Practice Address - Phone:201-993-6115
Practice Address - Fax:201-483-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00014600261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center