Provider Demographics
NPI:1972142602
Name:YURICK, NICOLAS RALPH (LAC)
Entity Type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:RALPH
Last Name:YURICK
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 1:27 HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:BLUE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11715-1420
Mailing Address - Country:US
Mailing Address - Phone:631-521-4574
Mailing Address - Fax:
Practice Address - Street 1:920 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2257
Practice Address - Country:US
Practice Address - Phone:631-256-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist