Provider Demographics
NPI:1609923150
Name:LEVENTHAL, ERIC S (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:LEVENTHAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 WASHINGTON ST
Mailing Address - Street 2:3M
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4598
Mailing Address - Country:US
Mailing Address - Phone:201-434-0034
Mailing Address - Fax:
Practice Address - Street 1:1949 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1717
Practice Address - Country:US
Practice Address - Phone:908-322-8887
Practice Address - Fax:908-322-7888
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00487900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7139306Medicaid
NJ7139306Medicaid