Provider Demographics
NPI:1518344134
Name:KARISA GRUDI ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:KARISA GRUDI ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRUDI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-417-2541
Mailing Address - Street 1:707 YORK RD
Mailing Address - Street 2:APT 5202
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2546
Mailing Address - Country:US
Mailing Address - Phone:201-417-2541
Mailing Address - Fax:410-337-8812
Practice Address - Street 1:744 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:201-417-2541
Practice Address - Fax:410-337-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01659171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU01659OtherSTATE LICENSE