Provider Demographics
NPI:1205492071
Name:QUEEN HERB ACUPUNCTURE PC
Entity type:Organization
Organization Name:QUEEN HERB ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYEWON
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-408-5700
Mailing Address - Street 1:720 E PALISADE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3054
Mailing Address - Country:US
Mailing Address - Phone:201-408-5700
Mailing Address - Fax:201-731-3045
Practice Address - Street 1:720 E PALISADE AVE STE 106
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3054
Practice Address - Country:US
Practice Address - Phone:201-408-5700
Practice Address - Fax:201-731-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty