Provider Demographics
NPI:1467799890
Name:AZ CLINIC
Entity Type:Organization
Organization Name:AZ CLINIC
Other - Org Name:NEWSONG CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:201-227-8275
Mailing Address - Street 1:333 SYLVAN AVE
Mailing Address - Street 2:#301
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2724
Mailing Address - Country:US
Mailing Address - Phone:201-227-8275
Mailing Address - Fax:201-227-6113
Practice Address - Street 1:333 SYLVAN AVE
Practice Address - Street 2:#301
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2724
Practice Address - Country:US
Practice Address - Phone:201-227-8275
Practice Address - Fax:201-227-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00067400171100000X
NJ25MZ00068300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty