Provider Demographics
NPI:1760691356
Name:PERRY, ERIKA CHARLOTTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:CHARLOTTE
Last Name:PERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6577
Mailing Address - Country:US
Mailing Address - Phone:631-585-9851
Mailing Address - Fax:631-588-9340
Practice Address - Street 1:2232 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6577
Practice Address - Country:US
Practice Address - Phone:631-585-9851
Practice Address - Fax:631-588-9340
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433790-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02757000Medicaid