Healthcare Provider Details

I. General information

NPI: 1184827115
Provider Name (Legal Business Name): ERIC DEMRY DAC, MPH, LAC, RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E 124TH ST APT 4C
NEW YORK NY
10035
US

IV. Provider business mailing address

205 E 124TH ST APT 4C
NEW YORK NY
10035-2001
US

V. Phone/Fax

Practice location:
  • Phone: 212-837-8071
  • Fax:
Mailing address:
  • Phone: 212-837-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002404
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12211
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1085359
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN007102
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: