Provider Demographics
NPI:1164523056
Name:WESTREICH, LAURENCE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:MICHAEL
Last Name:WESTREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BELLEVUE AVE
Mailing Address - Street 2:SIDE ENTRANCE
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1897
Mailing Address - Country:US
Mailing Address - Phone:973-509-1444
Mailing Address - Fax:
Practice Address - Street 1:202 BELLEVUE AVE
Practice Address - Street 2:SIDE ENTRANCE
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1897
Practice Address - Country:US
Practice Address - Phone:973-509-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA664242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E84083Medicare UPIN