Provider Demographics
NPI:1295126449
Name:SOWA, ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SOWA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2642
Mailing Address - Country:US
Mailing Address - Phone:609-924-7294
Mailing Address - Fax:
Practice Address - Street 1:88 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2642
Practice Address - Country:US
Practice Address - Phone:609-924-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00109600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist