Provider Demographics
NPI:1710207667
Name:DY ACUPUNCTURE CLINIC, INC
Entity Type:Organization
Organization Name:DY ACUPUNCTURE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-363-0233
Mailing Address - Street 1:2500 LEMOINE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6232
Mailing Address - Country:US
Mailing Address - Phone:201-363-0233
Mailing Address - Fax:201-363-0244
Practice Address - Street 1:2500 LEMOINE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6232
Practice Address - Country:US
Practice Address - Phone:201-363-0233
Practice Address - Fax:201-363-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00045000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center