Provider Demographics
NPI:1639737513
Name:REIBEN, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:REIBEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WARREN LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1431
Mailing Address - Country:US
Mailing Address - Phone:516-761-5204
Mailing Address - Fax:
Practice Address - Street 1:15 WARREN LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1431
Practice Address - Country:US
Practice Address - Phone:516-761-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program