Provider Demographics
NPI:1184170987
Name:URICH, JOHN (LAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:URICH
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 1:1651 LAWRENCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2901
Mailing Address - Country:US
Mailing Address - Phone:609-883-0080
Mailing Address - Fax:609-538-1969
Practice Address - Street 1:1651 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2901
Practice Address - Country:US
Practice Address - Phone:609-883-0080
Practice Address - Fax:609-538-1969
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00001300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist