Provider Demographics
NPI:1730624628
Name:LIBERTY ACUPUNCTURE & INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:LIBERTY ACUPUNCTURE & INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SUNG HO
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-706-7905
Mailing Address - Street 1:688 WESTWOOD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6375
Mailing Address - Country:US
Mailing Address - Phone:201-706-7905
Mailing Address - Fax:201-706-7905
Practice Address - Street 1:688 WESTWOOD AVE STE 2
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6375
Practice Address - Country:US
Practice Address - Phone:201-706-7905
Practice Address - Fax:201-706-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00072700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty