Provider Demographics
NPI:1033556345
Name:MCMAHON, ERIN
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 W GLANN RD
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-4026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:607-625-4251
Practice Address - Street 1:23 W GLANN RD
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-4026
Practice Address - Country:US
Practice Address - Phone:607-222-8977
Practice Address - Fax:607-625-4251
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYREG2081611-578416C3OtherNY STATE DEPT OF HEALTH BUREAU OF EARLY INTERVENTION