Provider Demographics
NPI:1629290101
Name:O'BRYAN, ERICA (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-10 GREENPOINT AVENUE GREENPOINT PEDIATRIC CENTER
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104
Mailing Address - Country:US
Mailing Address - Phone:718-389-2500
Mailing Address - Fax:718-389-6484
Practice Address - Street 1:47-10 GREENPOINT AVENUE GREENPOINT PEDIATRIC CENTER
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:718-389-2500
Practice Address - Fax:718-389-6484
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 105195208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001989300Medicaid
FLFT666ZMedicare PIN