Provider Demographics
NPI:1568671352
Name:SNYDER, DAVID ANDREW (LAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANDREW
Last Name:SNYDER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LINVALE RD
Mailing Address - Street 2:
Mailing Address - City:RINGOES
Mailing Address - State:NJ
Mailing Address - Zip Code:08551-1412
Mailing Address - Country:US
Mailing Address - Phone:908-447-8061
Mailing Address - Fax:908-245-6230
Practice Address - Street 1:236 E WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2084
Practice Address - Country:US
Practice Address - Phone:908-447-8061
Practice Address - Fax:908-245-6230
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00044000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11561514OtherCAQH IDENTIFICATION