MEDICARE: ENRIQUE BEER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	18KT00591700	NJ

General Provider Information

NPI Number	:	1700230042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE BEER

Provider Business Mailing Address
First Line	:	1803 MAIN ST
Second Line	:	SUITE 1C
City	:	LAKE COMO
State	:	NJ
Zip	:	07719-2957
Country	:	US
Telephone Number	:	732-504-8277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 MAIN ST
Second Line	:	SUITE 1C
City	:	LAKE COMO
State	:	NJ
Zip	:	07719-2957
Country	:	US
Telephone Number	:	732-504-8277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	04/22/2016

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Directions to “ ENRIQUE BEER ” Practice Location

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