Provider Demographics
NPI:1497003909
Name:PODSZUS, ERIK C (RPA, PHD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:C
Last Name:PODSZUS
Suffix:
Gender:M
Credentials:RPA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 VETERANS HWY
Mailing Address - Street 2:SUITE CL100
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2952
Mailing Address - Country:US
Mailing Address - Phone:631-257-5200
Mailing Address - Fax:631-257-5201
Practice Address - Street 1:700 VETERANS HWY
Practice Address - Street 2:SUITE CL100
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2952
Practice Address - Country:US
Practice Address - Phone:631-257-5200
Practice Address - Fax:631-257-5201
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002267-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant