Provider Demographics
NPI:1972711380
Name:EUN, SUSANNA (L AC)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:EUN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DEMERCURIO DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1717
Mailing Address - Country:US
Mailing Address - Phone:201-760-8811
Mailing Address - Fax:201-251-8728
Practice Address - Street 1:1 DEMERCURIO DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1717
Practice Address - Country:US
Practice Address - Phone:201-760-8811
Practice Address - Fax:201-251-8728
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00029100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist