Provider Demographics
NPI:1437709276
Name:BAN, ERICA (MS, RD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 BROADWAY RM 304
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2895
Mailing Address - Country:US
Mailing Address - Phone:917-968-3496
Mailing Address - Fax:
Practice Address - Street 1:2095 BROADWAY RM 304
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2895
Practice Address - Country:US
Practice Address - Phone:917-968-3496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
874043133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered