Provider Demographics
NPI:1417019845
Name:BRODKIN, ERIKA (DDS)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BRODKIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:OPEN DOOR FAMILY MEDICAL CENTERS, INC.
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4702
Mailing Address - Country:US
Mailing Address - Phone:914-941-1263
Mailing Address - Fax:914-941-0993
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:OPEN DOOR FAMILY MEDICAL CENTERS, INC.
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4702
Practice Address - Country:US
Practice Address - Phone:914-941-1263
Practice Address - Fax:914-941-0993
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050675-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02574023Medicaid