Provider Demographics
NPI:1528377793
Name:SURKIN, ERIKA L (MED)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:L
Last Name:SURKIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:CHESTER HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19017-0668
Mailing Address - Country:US
Mailing Address - Phone:610-368-6633
Mailing Address - Fax:
Practice Address - Street 1:363 VALLEYBROOK RD
Practice Address - Street 2:
Practice Address - City:CHESTER HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19017
Practice Address - Country:US
Practice Address - Phone:610-368-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004270-L103TB0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral