Provider Demographics
NPI:1336295187
Name:SMALL, ERIC WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:SMALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:280 N CENTRAL AVE STE 70
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1835
Mailing Address - Country:US
Mailing Address - Phone:914-666-7900
Mailing Address - Fax:914-666-7901
Practice Address - Street 1:280 N CENTRAL AVE STE 70
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1835
Practice Address - Country:US
Practice Address - Phone:914-666-7900
Practice Address - Fax:914-666-7901
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2019-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1851552080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF85846Medicare UPIN