Provider Demographics
NPI:1760214407
Name:ANDRADE, ROBERTO (LAC)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:ANDRADE
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 1:248 COLUMBIA TPKE STE 312
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1249
Mailing Address - Country:US
Mailing Address - Phone:973-944-8889
Mailing Address - Fax:
Practice Address - Street 1:248 COLUMBIA TPKE STE 312
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1249
Practice Address - Country:US
Practice Address - Phone:973-944-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00076800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist