Provider Demographics
NPI:1932885936
Name:MEDFORD, ERIK (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:MEDFORD
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DARLENE CT
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1676
Mailing Address - Country:US
Mailing Address - Phone:732-856-2161
Mailing Address - Fax:
Practice Address - Street 1:7 DARLENE CT
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1676
Practice Address - Country:US
Practice Address - Phone:732-856-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031365225700000X
NJ18KT00822300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist