Provider Demographics
NPI:1689099798
Name:PANG, JEFF (L AC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:PANG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LEIGH RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4245
Mailing Address - Country:US
Mailing Address - Phone:908-255-5132
Mailing Address - Fax:
Practice Address - Street 1:242 HWY 79 N STE 11
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-2079
Practice Address - Country:US
Practice Address - Phone:908-255-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005250171100000X
NJ25MZ00108800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist