1124338140 NPI number — OCEAN ACUPUNCTURE & HERBAL MEDICINE

Table of content: MR. JOSE ALFREDO BANDA OTR (NPI 1396070926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124338140 NPI number — OCEAN ACUPUNCTURE & HERBAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN ACUPUNCTURE & HERBAL MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124338140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 E BAY AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MANAHAWKIN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08050-3175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-978-1428
Provider Business Mailing Address Fax Number:
609-978-1428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 E BAY AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MANAHAWKIN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08050-3175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-978-1428
Provider Business Practice Location Address Fax Number:
609-978-1428
Provider Enumeration Date:
10/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MANZELLA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
ACUPUNCTURISTS
Authorized Official Telephone Number:
609-978-1428

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  Z5MZ00025000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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