Provider Demographics
NPI:1841315868
Name:ACUPUNCTURE FOR REHABILITATION AND HOLISTIC HEALTH
Entity type:Organization
Organization Name:ACUPUNCTURE FOR REHABILITATION AND HOLISTIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:IZRAILOV
Authorized Official - Suffix:
Authorized Official - Credentials:MHS,MA,LAC DIPNCCAOM
Authorized Official - Phone:973-303-0758
Mailing Address - Street 1:23 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1238
Mailing Address - Country:US
Mailing Address - Phone:973-303-0758
Mailing Address - Fax:
Practice Address - Street 1:1861 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2954
Practice Address - Country:US
Practice Address - Phone:973-303-0758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00050400261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service