Provider Demographics
NPI:1326581240
Name:SCANSAROLE, ERIN MARY (NP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MARY
Last Name:SCANSAROLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1802
Mailing Address - Country:US
Mailing Address - Phone:516-273-1476
Mailing Address - Fax:
Practice Address - Street 1:287 CHARLES AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PK
Practice Address - State:NY
Practice Address - Zip Code:11762-1802
Practice Address - Country:US
Practice Address - Phone:516-273-1476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30 307985363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health