Provider Demographics
NPI:1447918057
Name:SALTSBERG, ERIC (PHD, CPED, CFO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SALTSBERG
Suffix:
Gender:M
Credentials:PHD, CPED, CFO
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 290625
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-0625
Mailing Address - Country:US
Mailing Address - Phone:516-242-8070
Mailing Address - Fax:
Practice Address - Street 1:1474 W GRANADA BLVD STE 475
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8240
Practice Address - Country:US
Practice Address - Phone:386-451-1225
Practice Address - Fax:386-274-5156
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED147224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPED147OtherVOLUSIA HEALTH NETWORK