Provider Demographics
NPI:1922426550
Name:BLUEREN HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:BLUEREN HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FATMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINHAS-KUCUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-346-2616
Mailing Address - Street 1:282 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1829
Mailing Address - Country:US
Mailing Address - Phone:973-346-2616
Mailing Address - Fax:732-374-4090
Practice Address - Street 1:282 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1829
Practice Address - Country:US
Practice Address - Phone:973-346-2616
Practice Address - Fax:732-374-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00107300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty