Provider Demographics
NPI:1407661507
Name:GEDRICH, ANTHONY (LMT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:GEDRICH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 WOODBINE ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3609
Mailing Address - Country:US
Mailing Address - Phone:914-584-3477
Mailing Address - Fax:
Practice Address - Street 1:190 N 10TH ST STE 306
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9318
Practice Address - Country:US
Practice Address - Phone:914-584-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11405225700000X
NY033427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist