Provider Demographics
NPI:1295363794
Name:HENRIQUES, ALEXANDRIA ROSE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRIA
Middle Name:ROSE
Last Name:HENRIQUES
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 1:65 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1311
Mailing Address - Country:US
Mailing Address - Phone:732-841-3872
Mailing Address - Fax:
Practice Address - Street 1:315 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2459
Practice Address - Country:US
Practice Address - Phone:908-494-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006729-01171100000X
NJ25MZ00149200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty