Provider Demographics
NPI:1801201975
Name:WEBSTER, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WEBSTER
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 1:3652 HOOVER AVE
Mailing Address - Street 2:BUILDING
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760
Mailing Address - Country:US
Mailing Address - Phone:607-346-6023
Mailing Address - Fax:
Practice Address - Street 1:3652 HOOVER AVE
Practice Address - Street 2:BUILDING
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-3608
Practice Address - Country:US
Practice Address - Phone:607-346-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist