Provider Demographics
NPI:1508070160
Name:ADLER, ERIC (LAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:ADLER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-6125
Mailing Address - Country:US
Mailing Address - Phone:512-868-5779
Mailing Address - Fax:
Practice Address - Street 1:334 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-6125
Practice Address - Country:US
Practice Address - Phone:512-868-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000617171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist