Provider Demographics
NPI:1275697450
Name:ERIE NEUROSURGERY & ASSOC, INC
Entity Type:Organization
Organization Name:ERIE NEUROSURGERY & ASSOC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICENTA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GASPAR-YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-626-7070
Mailing Address - Street 1:703 TYLER ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3367
Mailing Address - Country:US
Mailing Address - Phone:419-626-7070
Mailing Address - Fax:419-609-0795
Practice Address - Street 1:703 TYLER ST
Practice Address - Street 2:SUITE 350
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3367
Practice Address - Country:US
Practice Address - Phone:419-626-7070
Practice Address - Fax:419-609-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9307861Medicare ID - Type UnspecifiedPRACTICE MEDICARE PROVIDE
OH3948760001Medicare NSC