Provider Demographics
NPI:1629880679
Name:BARRUCH, ADAM DANIEL (MSAC, LAC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DANIEL
Last Name:BARRUCH
Suffix:
Gender:M
Credentials:MSAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BALDWIN AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2002
Mailing Address - Country:US
Mailing Address - Phone:914-649-3261
Mailing Address - Fax:
Practice Address - Street 1:911 UNION ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1566
Practice Address - Country:US
Practice Address - Phone:914-649-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007564171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist