Provider Demographics
NPI:1679945422
Name:CONTEMPORARY INTEGRATIVE CARE ACUPUNCTURE, PLLC
Entity Type:Organization
Organization Name:CONTEMPORARY INTEGRATIVE CARE ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIHYUK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:646-549-9620
Mailing Address - Street 1:2050 CENTRAL RD
Mailing Address - Street 2:APT 701
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7333
Mailing Address - Country:US
Mailing Address - Phone:646-549-9620
Mailing Address - Fax:
Practice Address - Street 1:39 E 78TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0213
Practice Address - Country:US
Practice Address - Phone:646-549-9620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5203-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty