Provider Demographics
NPI:1699450510
Name:DAHL, ERIC A (LMT, ACMT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:A
Last Name:DAHL
Suffix:
Gender:M
Credentials:LMT, ACMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609A WALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROAD CHANNEL
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1043
Mailing Address - Country:US
Mailing Address - Phone:646-286-2814
Mailing Address - Fax:
Practice Address - Street 1:32 UNION SQ E APT 41
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3209
Practice Address - Country:US
Practice Address - Phone:838-777-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010599225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist