Provider Demographics
NPI:1356672885
Name:ONG, ERIC C
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:C
Last Name:ONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 W SAMPLE RD
Mailing Address - Street 2:UNIT 304
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3248
Mailing Address - Country:US
Mailing Address - Phone:575-640-3839
Mailing Address - Fax:
Practice Address - Street 1:5900 W SAMPLE RD
Practice Address - Street 2:UNIT 304
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3248
Practice Address - Country:US
Practice Address - Phone:575-640-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3703225100000X
PAPT020331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist