Healthcare Provider Details

I. General information

NPI: 1447918057
Provider Name (Legal Business Name): ERIC SALTSBERG PH.D., C.PED., CFO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1474 W GRANADA BLVD STE 475
ORMOND BEACH FL
32174-8240
US

IV. Provider business mailing address

PO BOX 290625
PORT ORANGE FL
32129-0625
US

V. Phone/Fax

Practice location:
  • Phone: 386-451-1225
  • Fax: 386-274-5156
Mailing address:
  • Phone: 516-242-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberPED147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: