Provider Demographics
NPI:1679629562
Name:CENTER FOR ACUPUNCTURE AND HERBAL MEDICINE, P.A.
Entity Type:Organization
Organization Name:CENTER FOR ACUPUNCTURE AND HERBAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, ACUPUNCTURIST, HERBALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MSTOM, LAC, CA,
Authorized Official - Phone:908-654-4333
Mailing Address - Street 1:166 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3131
Mailing Address - Country:US
Mailing Address - Phone:908-654-4333
Mailing Address - Fax:908-654-4633
Practice Address - Street 1:166 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3131
Practice Address - Country:US
Practice Address - Phone:908-654-4333
Practice Address - Fax:908-654-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ25MZ000020500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2361357Medicare UPIN