Provider Demographics
NPI:1861099855
Name:GARDEN STATE ACUPUNCTURE & HERBS PC
Entity type:Organization
Organization Name:GARDEN STATE ACUPUNCTURE & HERBS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYUNSOO
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-421-7733
Mailing Address - Street 1:4 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2307
Mailing Address - Country:US
Mailing Address - Phone:201-421-7733
Mailing Address - Fax:
Practice Address - Street 1:1060 MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2592
Practice Address - Country:US
Practice Address - Phone:201-421-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty