Provider Demographics
NPI:1588708010
Name:LAWRENCE CYRAN & MARIA G CRINCOLI
Entity type:Organization
Organization Name:LAWRENCE CYRAN & MARIA G CRINCOLI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CYRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-432-3693
Mailing Address - Street 1:944 WESTSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-6515
Mailing Address - Country:US
Mailing Address - Phone:201-432-3693
Mailing Address - Fax:201-432-3896
Practice Address - Street 1:944 WESTSIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-6515
Practice Address - Country:US
Practice Address - Phone:201-432-3693
Practice Address - Fax:201-432-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFED TAX ID #
=========OtherFED TAX ID #
NJX82412Medicare UPIN