Provider Demographics
NPI:1780059766
Name:ACUPUNCTURE EDEN
Entity type:Organization
Organization Name:ACUPUNCTURE EDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:908-370-4233
Mailing Address - Street 1:630 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1008
Mailing Address - Country:US
Mailing Address - Phone:908-370-4233
Mailing Address - Fax:908-888-0236
Practice Address - Street 1:630 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1008
Practice Address - Country:US
Practice Address - Phone:908-370-4233
Practice Address - Fax:908-888-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00099700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty