Provider Demographics
NPI:1528534625
Name:JERSEY SHORE ACUPUNCTURE
Entity Type:Organization
Organization Name:JERSEY SHORE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-996-3659
Mailing Address - Street 1:1000 SANGER AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1241
Mailing Address - Country:US
Mailing Address - Phone:732-996-3659
Mailing Address - Fax:
Practice Address - Street 1:JERSEY SHORE ACUPUNCTURE
Practice Address - Street 2:1000 SANGER AVE STE #205
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-0775
Practice Address - Country:US
Practice Address - Phone:732-996-3659
Practice Address - Fax:732-475-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1093010308OtherNPPES