Provider Demographics
NPI:1154757771
Name:THE CENTER FOR ACUPUNCTURE & MIND-BODY HEALTH
Entity type:Organization
Organization Name:THE CENTER FOR ACUPUNCTURE & MIND-BODY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:484-357-7899
Mailing Address - Street 1:2006 ROUTE 71
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-2273
Mailing Address - Country:US
Mailing Address - Phone:484-357-7899
Mailing Address - Fax:
Practice Address - Street 1:2006 ROUTE 71
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-2273
Practice Address - Country:US
Practice Address - Phone:484-357-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00093300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty