Provider Demographics
NPI:1700333523
Name:URBAN, TERESA (LAC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:URBAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 RARITAN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1344
Mailing Address - Country:US
Mailing Address - Phone:732-388-8828
Mailing Address - Fax:732-388-6788
Practice Address - Street 1:1139 RARITAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1344
Practice Address - Country:US
Practice Address - Phone:732-388-8828
Practice Address - Fax:732-388-6788
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00120900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist