Provider Demographics
NPI:1881203024
Name:BANTAM ACUPUNCTURE CLINIC LLC
Entity Type:Organization
Organization Name:BANTAM ACUPUNCTURE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DAC
Authorized Official - Phone:802-373-2352
Mailing Address - Street 1:622 BANTAM RD
Mailing Address - Street 2:
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-1600
Mailing Address - Country:US
Mailing Address - Phone:802-373-2352
Mailing Address - Fax:
Practice Address - Street 1:624 BANTAM RD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-1600
Practice Address - Country:US
Practice Address - Phone:802-373-2352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty