Provider Demographics
NPI:1639342892
Name:THE ATLANTIC CENTER FOR ACUPUNCTURE AND ORIENAL MEDICINE, LLC
Entity Type:Organization
Organization Name:THE ATLANTIC CENTER FOR ACUPUNCTURE AND ORIENAL MEDICINE, LLC
Other - Org Name:THE ATLANTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALFONS
Authorized Official - Last Name:BALKO
Authorized Official - Suffix:
Authorized Official - Credentials:CA, L AC
Authorized Official - Phone:732-775-0033
Mailing Address - Street 1:2002 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4674
Mailing Address - Country:US
Mailing Address - Phone:732-775-0033
Mailing Address - Fax:732-775-0038
Practice Address - Street 1:2002 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4674
Practice Address - Country:US
Practice Address - Phone:732-775-0033
Practice Address - Fax:732-775-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00041500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty