Provider Demographics
NPI:1790139343
Name:CARLY DRUCK, LLC.
Entity Type:Organization
Organization Name:CARLY DRUCK, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:973-634-7569
Mailing Address - Street 1:1 LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-1943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-1943
Practice Address - Country:US
Practice Address - Phone:973-634-7569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00072200302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization