Provider Demographics
NPI:1265707939
Name:PROSPERITY HEALTH CENTER LLC
Entity type:Organization
Organization Name:PROSPERITY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENG
Authorized Official - Middle Name:
Authorized Official - Last Name:KUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-696-8282
Mailing Address - Street 1:952 HIGHWAY 34
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3258
Mailing Address - Country:US
Mailing Address - Phone:732-696-8282
Mailing Address - Fax:
Practice Address - Street 1:952 HIGHWAY 34
Practice Address - Street 2:SUITE 207
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3258
Practice Address - Country:US
Practice Address - Phone:732-696-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty