Provider Demographics
NPI:1891117891
Name:VBACUPUNCTURE
Entity Type:Organization
Organization Name:VBACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST AND HERBALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOMAZOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:908-338-1077
Mailing Address - Street 1:254 DAFFODIL DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4071
Mailing Address - Country:US
Mailing Address - Phone:732-858-1548
Mailing Address - Fax:
Practice Address - Street 1:265 STATE ROUTE 34
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2435
Practice Address - Country:US
Practice Address - Phone:732-858-1548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00101400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty