Provider Demographics
NPI:1659747301
Name:BAILEY, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:UNIT 100A
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2601
Mailing Address - Country:US
Mailing Address - Phone:914-771-6200
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:UNIT 100A
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2601
Practice Address - Country:US
Practice Address - Phone:914-771-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer