Provider Demographics
NPI:1538414487
Name:HAEDRICH, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:HAEDRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 KENNEDY BLVD STE C11
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5568
Mailing Address - Country:US
Mailing Address - Phone:917-363-6312
Mailing Address - Fax:
Practice Address - Street 1:2787 KENNEDY BLVD STE C11
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5568
Practice Address - Country:US
Practice Address - Phone:917-363-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00050000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist