Provider Demographics
NPI:1871617613
Name:BRANCH, ROBERT LAURIE (L AC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LAURIE
Last Name:BRANCH
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 EAST 28 STREET
Mailing Address - Street 2:# 17
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-686-0841
Mailing Address - Fax:
Practice Address - Street 1:400 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07220
Practice Address - Country:US
Practice Address - Phone:212-920-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001139171100000X
NJ25MZ00046900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist