Healthcare Provider Details

I. General information

NPI: 1700230042
Provider Name (Legal Business Name): ENRIQUE BEER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 MAIN ST SUITE 1C
LAKE COMO NJ
07719-2957
US

IV. Provider business mailing address

1803 MAIN ST SUITE 1C
LAKE COMO NJ
07719-2957
US

V. Phone/Fax

Practice location:
  • Phone: 732-504-8277
  • Fax:
Mailing address:
  • Phone: 732-504-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00591700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: