Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | MC 05658 | NJ |
NPI | 1083690432 |
---|---|
Provider Name | Dr. Eric Anthony Waldorf |
First Address | Bridgewater, NJ 08807-2020 |
Second Address | Bridgewater, NJ 08807-2020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 21/09/2011 |