Provider Demographics
NPI:1982837423
Name:STIVERS, ERIC W (PT,DPT,OCS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
Last Name:STIVERS
Suffix:
Gender:M
Credentials:PT,DPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-0684
Mailing Address - Country:US
Mailing Address - Phone:973-396-8585
Mailing Address - Fax:973-396-8587
Practice Address - Street 1:321 CHANGEBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9583
Practice Address - Country:US
Practice Address - Phone:973-396-8585
Practice Address - Fax:973-396-8587
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01324200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ166864XBWMedicare PIN