Provider Demographics
NPI:1184310922
Name:JY MOON ACUPUNCTURE WELLNESS AND HERBS PC
Entity type:Organization
Organization Name:JY MOON ACUPUNCTURE WELLNESS AND HERBS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JIYONG
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:973-986-2655
Mailing Address - Street 1:942 BANTA PL APT B
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-3708
Mailing Address - Country:US
Mailing Address - Phone:973-986-2655
Mailing Address - Fax:
Practice Address - Street 1:570 PIERMONT RD STE A7-1
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-3100
Practice Address - Country:US
Practice Address - Phone:201-654-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty