Provider Demographics
NPI:1699206409
Name:PERCY A ERACHSHAW D.O. PLLC
Entity Type:Organization
Organization Name:PERCY A ERACHSHAW D.O. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERACHSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-418-4700
Mailing Address - Street 1:53 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-2601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5303
Practice Address - Country:US
Practice Address - Phone:718-418-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty