Provider Demographics
NPI:1396240636
Name:NA, EUN YOUNG (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:EUN YOUNG
Middle Name:
Last Name:NA
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BROAD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1631
Mailing Address - Country:US
Mailing Address - Phone:201-304-7027
Mailing Address - Fax:
Practice Address - Street 1:440 BROAD AVE # 2
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1631
Practice Address - Country:US
Practice Address - Phone:201-304-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005985171100000X
NJ25MZ00127000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist