Provider Demographics
NPI:1497205702
Name:WRIGHT, WILLIAM R JR (LAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:LAC
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Mailing Address - Street 1:600 HUDSON ST
Mailing Address - Street 2:APT. 2C
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5900
Mailing Address - Country:US
Mailing Address - Phone:706-604-1460
Mailing Address - Fax:
Practice Address - Street 1:106 4TH ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4837
Practice Address - Country:US
Practice Address - Phone:201-526-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005795171100000X
NJ25MZ00122000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist