Provider Demographics
NPI:1740087303
Name:SPORTSMED ACUPUNTURE OF NEW JERSEY, LLC
Entity type:Organization
Organization Name:SPORTSMED ACUPUNTURE OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, RCM
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-857-0527
Mailing Address - Street 1:266 HARRISTOWN RD STE 304
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3321
Mailing Address - Country:US
Mailing Address - Phone:973-767-2880
Mailing Address - Fax:
Practice Address - Street 1:266 HARRISTOWN RD STE 200
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3354
Practice Address - Country:US
Practice Address - Phone:201-445-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPORTSMED PT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty