Provider Demographics
NPI:1104894534
Name:CHLUDZINSKI, ERIC P
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:CHLUDZINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 BROADWAY
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-339-8889
Mailing Address - Fax:201-339-2822
Practice Address - Street 1:564 BROADWAY
Practice Address - Street 2:SUITE 2A
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-339-8889
Practice Address - Fax:201-339-2822
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00600200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071404WRTMedicare PIN