Provider Demographics
NPI:1174989719
Name:BE WELL ORIENTAL MEDICINE
Entity type:Organization
Organization Name:BE WELL ORIENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYONG OK
Authorized Official - Middle Name:
Authorized Official - Last Name:OM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-913-3977
Mailing Address - Street 1:8200 BOULEVARD E APT 28L
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6045
Mailing Address - Country:US
Mailing Address - Phone:201-913-3977
Mailing Address - Fax:888-534-5993
Practice Address - Street 1:841 KEARNY AVE APT 1
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3249
Practice Address - Country:US
Practice Address - Phone:201-913-3977
Practice Address - Fax:888-534-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00107700171100000X
NY005008171100000X
NY005016171100000X
NJ25MZ00099600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty