Provider Demographics
NPI:1649549536
Name:MODERN ACUPUNCTURE
Entity type:Organization
Organization Name:MODERN ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:973-904-0400
Mailing Address - Street 1:169 UNION BLVD STE 2B
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2603
Mailing Address - Country:US
Mailing Address - Phone:973-973-0400
Mailing Address - Fax:973-973-0600
Practice Address - Street 1:169 UNION BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2603
Practice Address - Country:US
Practice Address - Phone:973-904-0400
Practice Address - Fax:973-904-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service