Provider Demographics
NPI:1013219385
Name:GOSS, ERICA CARYN (MA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:CARYN
Last Name:GOSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 E 61ST ST
Mailing Address - Street 2:4FN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8558
Mailing Address - Country:US
Mailing Address - Phone:917-826-0409
Mailing Address - Fax:
Practice Address - Street 1:252 E 61ST ST
Practice Address - Street 2:4FN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8558
Practice Address - Country:US
Practice Address - Phone:917-826-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist