Provider Demographics
NPI:1679383343
Name:CORAL DRAGON ACUPUNCTURE
Entity type:Organization
Organization Name:CORAL DRAGON ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-202-6859
Mailing Address - Street 1:21 ASHWOOD TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5901
Mailing Address - Country:US
Mailing Address - Phone:862-202-6859
Mailing Address - Fax:
Practice Address - Street 1:366 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2737
Practice Address - Country:US
Practice Address - Phone:862-926-9578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATURALIGHT HEALING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty