Provider Demographics
NPI:1922677079
Name:SCHREIBER, ERIK JON
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:JON
Last Name:SCHREIBER
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 1:6 OCEANWILLOW DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970-2922
Mailing Address - Country:US
Mailing Address - Phone:703-626-3157
Mailing Address - Fax:
Practice Address - Street 1:29 ATLANTIC AVE STE K
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-9155
Practice Address - Country:US
Practice Address - Phone:703-626-3157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach