Provider Demographics
NPI:1497112015
Name:RENATURE ACUPUNCTURE PC
Entity Type:Organization
Organization Name:RENATURE ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-851-8885
Mailing Address - Street 1:8400 RIVER RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6244
Mailing Address - Country:US
Mailing Address - Phone:201-851-8885
Mailing Address - Fax:201-851-8885
Practice Address - Street 1:8400 RIVER RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6244
Practice Address - Country:US
Practice Address - Phone:201-851-8885
Practice Address - Fax:201-851-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty