Provider Demographics
NPI:1790334555
Name:PENICK INTEGRATIVE ACUPUNCTURE
Entity Type:Organization
Organization Name:PENICK INTEGRATIVE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHALIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PENICK
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LAC
Authorized Official - Phone:856-534-6282
Mailing Address - Street 1:521 ERIAL RD
Mailing Address - Street 2:
Mailing Address - City:PINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6301
Mailing Address - Country:US
Mailing Address - Phone:856-534-6282
Mailing Address - Fax:856-627-4556
Practice Address - Street 1:521 ERIAL RD
Practice Address - Street 2:
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021-6301
Practice Address - Country:US
Practice Address - Phone:856-534-6282
Practice Address - Fax:856-627-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty