Provider Demographics
NPI:1326003500
Name:VISCONTI-FERRARA, ERICA (DO)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:VISCONTI-FERRARA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3800
Mailing Address - Country:US
Mailing Address - Phone:516-663-4944
Mailing Address - Fax:516-663-8273
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:MINEOLA
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8693
Practice Address - Fax:516-663-8964
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197247-1208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP710885OtherOXFORD
NY01831314Medicaid
NY2599590OtherGHI
NYG57209Medicare UPIN
NY01831314Medicaid