Provider Demographics
NPI:1508205907
Name:ADAMS, ERIN P (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:P
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:P
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:600 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2125 RIVER RD
Practice Address - Street 2:SUITE 302
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-1135
Practice Address - Country:US
Practice Address - Phone:518-243-1313
Practice Address - Fax:518-831-7007
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
200268352001OtherCDPHP
131122000076OtherFIDELIS CARE OF NEW YORK
00424259001OtherBLUE SHIELD OF NENY
NYJ400091433Medicare PIN