Provider Demographics
NPI:1164519237
Name:PHILLIPS, ERICA G (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:G
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E 70TH ST # HT4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4872
Mailing Address - Country:US
Mailing Address - Phone:212-746-0373
Mailing Address - Fax:212-746-7481
Practice Address - Street 1:3611 21ST ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4705
Practice Address - Country:US
Practice Address - Phone:718-482-7772
Practice Address - Fax:718-482-9648
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331009OtherFQHC MEDICARE PROVIDER ID
NY02384825Medicaid
NYH33695Medicare UPIN