Provider Demographics
NPI:1093098493
Name:REYNA PACHECO, ERIKA ZINKA
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:ZINKA
Last Name:REYNA PACHECO
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 1:814 KNICKERBOCKER AVE
Mailing Address - Street 2:APT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-1337
Mailing Address - Country:US
Mailing Address - Phone:914-258-6053
Mailing Address - Fax:
Practice Address - Street 1:814 KNICKERBOCKER AVE
Practice Address - Street 2:2L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-1337
Practice Address - Country:US
Practice Address - Phone:914-258-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020663-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist