Active NPI
Nicholas Kodjak, CA, MA
- Acupuncturist
- Montclair, NJ
National Provider Identifier
1679733133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 25MZ00061100
- Practice address
- 70 Park St
Montclair, NJ 07042-5907 - Phone
- (973) 746-7766
- NPI assigned
- Jun 9, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 25MZ00061100 | NJ | Primary |
Addresses
Primary practice location
70 Park St
Montclair, NJ 07042-5907
Mailing address
70 Park St
Montclair, NJ 07042-5907
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MZ00061100 | NJ | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212969600000",
"number": "1679733133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 PARK ST",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "070425907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "70 PARK ST",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "070425907",
"telephone_number": "973-746-7766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODJAK",
"first_name": "NICHOLAS",
"name_prefix": "Mr.",
"credential": "CA, MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-09",
"last_updated": "2008-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NJ",
"license": "25MZ00061100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montclair, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.