Provider Demographics
NPI:1386287605
Name:TAKACS, KRISTIA ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:KRISTIA
Middle Name:ELIZABETH
Last Name:TAKACS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SANGER AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1241
Mailing Address - Country:US
Mailing Address - Phone:732-996-3659
Mailing Address - Fax:
Practice Address - Street 1:1000 SANGER AVE STE 205
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1241
Practice Address - Country:US
Practice Address - Phone:732-996-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00142300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty