Provider Demographics
NPI:1770784605
Name:BAYSHORE ACUPUNCTURE & TRADITIONAL MEDICINE
Entity type:Organization
Organization Name:BAYSHORE ACUPUNCTURE & TRADITIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAI
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:732-888-2088
Mailing Address - Street 1:4 LILY CT
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1473
Mailing Address - Country:US
Mailing Address - Phone:732-888-2088
Mailing Address - Fax:
Practice Address - Street 1:721 N BEERS ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1518
Practice Address - Country:US
Practice Address - Phone:732-888-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYSHORE ACUPUNCTURE & TRADITIONAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-29
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00047600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty