Provider Demographics
NPI:1053617209
Name:EAST WEST INTEGRATIVE HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:EAST WEST INTEGRATIVE HEALTH CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN, LICENSED ACUPUNCT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:ND, MSOM, LAC
Authorized Official - Phone:203-988-7483
Mailing Address - Street 1:217 MONTOWESE ST.
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3993
Mailing Address - Country:US
Mailing Address - Phone:203-915-9125
Mailing Address - Fax:203-643-4340
Practice Address - Street 1:217 MONTOWESE ST.
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3993
Practice Address - Country:US
Practice Address - Phone:203-915-9125
Practice Address - Fax:203-643-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000502171100000X
OR1642175F00000X
CT000432175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty