Provider Demographics
NPI:1699026625
Name:ATLANTIC ACUPUNCTURE & ORIENTAL MEDICAL CENTER
Entity type:Organization
Organization Name:ATLANTIC ACUPUNCTURE & ORIENTAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:386-947-9009
Mailing Address - Street 1:721 RIDGEWOOD AVE
Mailing Address - Street 2:#9
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3646
Mailing Address - Country:US
Mailing Address - Phone:386-947-9009
Mailing Address - Fax:386-947-9232
Practice Address - Street 1:721 RIDGEWOOD AVE
Practice Address - Street 2:#9
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-3646
Practice Address - Country:US
Practice Address - Phone:386-947-9009
Practice Address - Fax:386-947-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1615171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty