Provider Demographics
NPI:1720444243
Name:FHL TCM CLINIC
Entity type:Organization
Organization Name:FHL TCM CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:XIANRUI
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-788-3990
Mailing Address - Street 1:43 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1035
Mailing Address - Country:US
Mailing Address - Phone:732-788-3990
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:STE 39
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-788-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty