Provider Demographics
NPI:1710432232
Name:VINELAND COMMUNITY ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:VINELAND COMMUNITY ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMANIOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:856-457-5217
Mailing Address - Street 1:1672 N DELSEA DR
Mailing Address - Street 2:UNITE A7
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-2547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1672 N DELSEA DR
Practice Address - Street 2:UNITE A7
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-2547
Practice Address - Country:US
Practice Address - Phone:856-457-5217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00096300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty