Provider Demographics
NPI:1629352828
Name:DEEB, ERIN GROGAN (PA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:GROGAN
Last Name:DEEB
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1205 TROY SCHENECTADY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1074
Mailing Address - Country:US
Mailing Address - Phone:518-348-3176
Mailing Address - Fax:
Practice Address - Street 1:11835 RT 9W
Practice Address - Street 2:
Practice Address - City:WEST COXSACKIE
Practice Address - State:NY
Practice Address - Zip Code:12192-3605
Practice Address - Country:US
Practice Address - Phone:518-731-9000
Practice Address - Fax:518-731-9119
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2022-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYP81729363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical