Provider Demographics
NPI:1730486341
Name:ABSOLUTE BALANCE ACUPUNCTURE CLINIC LLC
Entity Type:Organization
Organization Name:ABSOLUTE BALANCE ACUPUNCTURE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-916-0509
Mailing Address - Street 1:28 WILSON PL
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2321
Mailing Address - Country:US
Mailing Address - Phone:201-916-0509
Mailing Address - Fax:201-815-2073
Practice Address - Street 1:25-15 FAIR LAWN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3434
Practice Address - Country:US
Practice Address - Phone:201-916-0509
Practice Address - Fax:201-815-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00055800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty