Healthcare Provider Details

I. General information

NPI: 1083690432
Provider Name (Legal Business Name): ERIC ANTHONY WALDORF DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PRINCE RODGERS AVE
BRIDGEWATER NJ
08807-2020
US

IV. Provider business mailing address

1301 PRINCE RODGERS AVE
BRIDGEWATER NJ
08807-2020
US

V. Phone/Fax

Practice location:
  • Phone: 908-541-1717
  • Fax: 908-541-0539
Mailing address:
  • Phone: 908-541-1717
  • Fax: 908-541-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberMC 05658
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: