Provider Demographics
NPI:1477722627
Name:HO, M. MAI-TRAM D (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:M. MAI-TRAM
Middle Name:D
Last Name:HO
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:973-955-6699
Mailing Address - Fax:973-467-3300
Practice Address - Street 1:58 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-955-6699
Practice Address - Fax:973-467-3300
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00660400111N00000X
NJ25MZ00102600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPTAN # 141055Medicare PIN