Provider Demographics
NPI:1760992721
Name:RADIANT HEALTH ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:RADIANT HEALTH ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:973-544-8381
Mailing Address - Street 1:318 MAIN ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1181
Mailing Address - Country:US
Mailing Address - Phone:973-544-8381
Mailing Address - Fax:
Practice Address - Street 1:318 MAIN ST STE 200A
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-544-8381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty