Provider Demographics
NPI:1881018364
Name:HUDERWITZ, DANIELLE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:HUDERWITZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EAGLE AVENUE
Mailing Address - Street 2:SEAVIEW ORTHOPEDICS
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-660-6200
Mailing Address - Fax:732-660-6221
Practice Address - Street 1:1200 EAGLE AVENUE
Practice Address - Street 2:SEAVIEW ORTHOPEDICS
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712
Practice Address - Country:US
Practice Address - Phone:732-660-6200
Practice Address - Fax:732-660-6221
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00499800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18KT00499800OtherSTATE OF NEW JERSEY, MASSAGE THERAPY LICENSE