Provider Demographics
NPI:1306198668
Name:MARRERO, ERICA (LAC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MARRERO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 W 239TH ST
Mailing Address - Street 2:SUITE 7H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1258
Mailing Address - Country:US
Mailing Address - Phone:646-875-8767
Mailing Address - Fax:
Practice Address - Street 1:2600 NETHERLAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4801
Practice Address - Country:US
Practice Address - Phone:646-875-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004837171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist