# GARDEN STATE ACUPUNCTURE AND WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093167991
- **Authorized official:** DR. KEVIN CLARK DAOM, L.AC. (OWNER)
- **Authorized official phone:** (302) 249-0143

## Contact information

- **Practice address:** 415 ROUTE 34, SUITE 210, COLTS NECK, NJ 07722-2522
- **Practice address phone:** (302) 249-0143
- **Practice address fax:** (732) 775-3515
- **Mailing address:** 1116 5TH AVE, ASBURY PARK, NJ 07712-4905
- **Mailing address phone:** (302) 249-0143
- **Mailing address fax:** (732) 775-3515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | 25MZ00104200 | NJ | Yes |
| 225700000X | Massage Therapist | 18KT00938000 | NJ | — |

## Other

- **Enumeration date:** 07/05/2016
- **Last updated:** 03/03/2017