Provider Demographics
NPI:1417219205
Name:MASTRIANNI, ERIK ANTHONY
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:ANTHONY
Last Name:MASTRIANNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 STATE ROUTE 9
Mailing Address - Street 2:MUNICIPAL CENTER
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-3434
Mailing Address - Country:US
Mailing Address - Phone:518-859-2877
Mailing Address - Fax:518-761-6354
Practice Address - Street 1:1340 STATE ROUTE 9
Practice Address - Street 2:MUNICIPAL CENTER
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845-3434
Practice Address - Country:US
Practice Address - Phone:518-859-2877
Practice Address - Fax:518-761-6354
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator