Provider Demographics
NPI:1689286007
Name:KOAM ACUPUNCTURE & HERBS
Entity Type:Organization
Organization Name:KOAM ACUPUNCTURE & HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-913-3977
Mailing Address - Street 1:300 WINSTON DR APT 615
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3213
Mailing Address - Country:US
Mailing Address - Phone:201-913-3977
Mailing Address - Fax:888-534-5993
Practice Address - Street 1:901 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3012
Practice Address - Country:US
Practice Address - Phone:201-913-3977
Practice Address - Fax:888-534-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty