Provider Demographics
NPI:1295622280
Name:BLUE HERON VITALITY LLC
Entity type:Organization
Organization Name:BLUE HERON VITALITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURACK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:603-455-7146
Mailing Address - Street 1:369 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1652
Mailing Address - Country:US
Mailing Address - Phone:603-455-7146
Mailing Address - Fax:
Practice Address - Street 1:369 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1652
Practice Address - Country:US
Practice Address - Phone:603-455-7146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty