Provider Demographics
NPI:1912346545
Name:MAGUIRE, LAURENCE PATRICK IV (LAC)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:PATRICK
Last Name:MAGUIRE
Suffix:IV
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 1:50 BROADWAY
Mailing Address - Street 2:APT #2
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2774
Mailing Address - Country:US
Mailing Address - Phone:917-697-1712
Mailing Address - Fax:
Practice Address - Street 1:464 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2956
Practice Address - Country:US
Practice Address - Phone:718-442-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001616171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist