Provider Demographics
NPI:1972811800
Name:ELDRIDGE, BRIAN JOHN II
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JOHN
Last Name:ELDRIDGE
Suffix:II
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 1:35 REVERE PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1518
Mailing Address - Country:US
Mailing Address - Phone:716-698-1144
Mailing Address - Fax:
Practice Address - Street 1:35 REVERE PL
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1518
Practice Address - Country:US
Practice Address - Phone:716-698-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016791-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics