Basic Information
| Provider Information | |||||||||
| NPI: | 1871544700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ULRICH | ||||||||
| FirstName: | SPENCER | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 PINE GROVE RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079221619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084646496 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 68 RIVER RD | ||||||||
| Address2: | C/O EQUINOX | ||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079011450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082770800 | ||||||||
| FaxNumber: | 9082770808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 09/14/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 025473 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 40QA01437800 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.