Provider Demographics
NPI:1083906192
Name:COLLIGAN, ERICA (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:COLLIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NORTHERN BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5207
Mailing Address - Country:US
Mailing Address - Phone:516-325-7000
Mailing Address - Fax:516-325-7001
Practice Address - Street 1:611 NORTHERN BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5207
Practice Address - Country:US
Practice Address - Phone:516-325-7000
Practice Address - Fax:516-325-7001
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-07
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 390200000X
NY2825002084N0400X, 2084N0400X
MN591052084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology