Provider Demographics
NPI:1699438259
Name:TWELVE RIVERS ACUPUNCTURE, PC
Entity type:Organization
Organization Name:TWELVE RIVERS ACUPUNCTURE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEATHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:646-691-7482
Mailing Address - Street 1:261 BLACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3067
Mailing Address - Country:US
Mailing Address - Phone:646-691-7482
Mailing Address - Fax:908-852-1402
Practice Address - Street 1:176 MOUNTAIN AVE STE 2B
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2434
Practice Address - Country:US
Practice Address - Phone:908-850-1400
Practice Address - Fax:908-852-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MZ00091300OtherACUPUNCTURE LICENSE