Provider Demographics
NPI:1013776087
Name:MONTVALE ACUPUNCTURE AND PAIN CENTER, INC
Entity Type:Organization
Organization Name:MONTVALE ACUPUNCTURE AND PAIN CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIN HO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-543-3667
Mailing Address - Street 1:135 CHESTNUT RIDGE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1152
Mailing Address - Country:US
Mailing Address - Phone:201-270-0900
Mailing Address - Fax:201-502-0654
Practice Address - Street 1:135 CHESTNUT RIDGE RD STE 250
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1152
Practice Address - Country:US
Practice Address - Phone:201-270-0900
Practice Address - Fax:201-502-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty