Provider Demographics
NPI:1861940678
Name:LIFESTYLE ACUPUNCTURE OF NEW JERSEY
Entity type:Organization
Organization Name:LIFESTYLE ACUPUNCTURE OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KAYLEIGH
Authorized Official - Middle Name:LAVENDER
Authorized Official - Last Name:CALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:973-919-6674
Mailing Address - Street 1:471 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3114
Mailing Address - Country:US
Mailing Address - Phone:973-919-6674
Mailing Address - Fax:
Practice Address - Street 1:471 GLEN RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3114
Practice Address - Country:US
Practice Address - Phone:973-919-6674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00095600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty