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General NPI Number Information
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NPI Number | 1992287387
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Entity Type | Individual
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Provider Name | BETHA HUNNICUTT ERTZBERGER CPED
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Gender | Female
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 2905 VETERANS MEMORIAL HWY STE 2
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City | RONKONKOMA
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State | NY
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Zip | 11779-7655
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Country | US
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Telephone | 631-619-8505
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 ARMSTRONG PARK DR
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City | GASTONIA
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State | NC
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Zip | 28054-4889
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Country | US
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Telephone | 704-747-6579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224L00000X
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Taxonomy Name | Pedorthist
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License Number |
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License Number State |
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