Provider Demographics
NPI:1639240278
Name:ERIKA CONNOR, LLP
Entity Type:Organization
Organization Name:ERIKA CONNOR, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-358-2340
Mailing Address - Street 1:111 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772-1131
Mailing Address - Country:US
Mailing Address - Phone:716-358-2340
Mailing Address - Fax:716-358-2350
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NY
Practice Address - Zip Code:14772-1131
Practice Address - Country:US
Practice Address - Phone:716-358-2340
Practice Address - Fax:716-358-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1502Medicare PIN
NY01042479Medicaid