Provider Demographics
NPI:1134521594
Name:SHUDA, ERIC JR (MEDICAL MASSAGE)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:SHUDA
Suffix:JR
Gender:M
Credentials:MEDICAL MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SADDLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1901
Mailing Address - Country:US
Mailing Address - Phone:973-267-7200
Mailing Address - Fax:
Practice Address - Street 1:15 SADDLE RD STE A
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1901
Practice Address - Country:US
Practice Address - Phone:973-267-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00623400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist