Provider Demographics
NPI:1053810408
Name:INTEGRATIVE ACUPUNCTURE LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:INTEGRATIVE ACUPUNCTURE LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:201-444-7150
Mailing Address - Street 1:69 W RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3142
Mailing Address - Country:US
Mailing Address - Phone:201-444-7150
Mailing Address - Fax:800-675-9860
Practice Address - Street 1:69 W RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3142
Practice Address - Country:US
Practice Address - Phone:201-444-7150
Practice Address - Fax:800-675-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMZ0000107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty