Healthcare Provider Details

I. General information

NPI: 1407661507
Provider Name (Legal Business Name): ANTHONY GEDRICH LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 N 10TH ST STE 306
BROOKLYN NY
11211-9318
US

IV. Provider business mailing address

1717 WOODBINE ST APT 3R
RIDGEWOOD NY
11385-3609
US

V. Phone/Fax

Practice location:
  • Phone: 914-584-3477
  • Fax:
Mailing address:
  • Phone: 914-584-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11405
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number033427
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: