Provider Demographics
NPI:1134155450
Name:LAURIE R. MULLEN DC, PC
Entity type:Organization
Organization Name:LAURIE R. MULLEN DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-543-4325
Mailing Address - Street 1:620 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3929
Mailing Address - Country:US
Mailing Address - Phone:212-543-4325
Mailing Address - Fax:212-543-4324
Practice Address - Street 1:620 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3929
Practice Address - Country:US
Practice Address - Phone:212-543-4325
Practice Address - Fax:212-543-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0101371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty