Provider Demographics
NPI:1093010308
Name:SPAETH, MEGAN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:SPAETH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SANGER AVENUE STE #205
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757
Mailing Address - Country:US
Mailing Address - Phone:732-996-3659
Mailing Address - Fax:
Practice Address - Street 1:1000 SANGER AVE STE 205
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1241
Practice Address - Country:US
Practice Address - Phone:732-996-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00069600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist