Provider Demographics
NPI:1366670523
Name:DE LA MAR, CRISTINA R (MS, LAC)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:R
Last Name:DE LA MAR
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2542
Mailing Address - Country:US
Mailing Address - Phone:917-210-1063
Mailing Address - Fax:
Practice Address - Street 1:150 MORRIS AVE STE 305
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1329
Practice Address - Country:US
Practice Address - Phone:917-210-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3980171100000X
NJ25MZ00113800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist