Provider Demographics
NPI:1497380489
Name:GUNDEL, ERIK (MT-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:GUNDEL
Suffix:
Gender:M
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 METROPOLITAN AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2625
Mailing Address - Country:US
Mailing Address - Phone:802-999-6426
Mailing Address - Fax:
Practice Address - Street 1:6931 62ND ST APT 2
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5215
Practice Address - Country:US
Practice Address - Phone:802-999-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002441225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist