Provider Demographics
NPI:1508841305
Name:LARSEN, ERIK SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:SCOTT
Last Name:LARSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:780 ROUTE 37W STE 330
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6430
Mailing Address - Country:US
Mailing Address - Phone:732-966-6317
Mailing Address - Fax:732-998-8086
Practice Address - Street 1:780 ROUTE 37 W STE 330
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5064
Practice Address - Country:US
Practice Address - Phone:732-966-6317
Practice Address - Fax:732-998-8086
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB69402207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG98526Medicare UPIN