Provider Demographics
NPI:1659510535
Name:EAST COAST ACUPUNCTURE & HERBS, LLC
Entity type:Organization
Organization Name:EAST COAST ACUPUNCTURE & HERBS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MANEGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:DA
Authorized Official - Phone:401-437-6633
Mailing Address - Street 1:111 CHESTNUT ST
Mailing Address - Street 2:LOWER LEVEL B
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4169
Mailing Address - Country:US
Mailing Address - Phone:401-437-6633
Mailing Address - Fax:401-654-6650
Practice Address - Street 1:111 CHESTNUT ST
Practice Address - Street 2:LOWER LEVEL B
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4169
Practice Address - Country:US
Practice Address - Phone:401-437-6633
Practice Address - Fax:401-654-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00303171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty