Provider Demographics
NPI:1831471739
Name:GENEROSO, ERIKA (PT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:GENEROSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:MABELLE
Other - Last Name:HOMOROC GENEROSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8682 MIDLAND PKWY
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3025
Mailing Address - Country:US
Mailing Address - Phone:718-753-6228
Mailing Address - Fax:
Practice Address - Street 1:8682 MIDLAND PKWY
Practice Address - Street 2:FLOOR 3
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3025
Practice Address - Country:US
Practice Address - Phone:718-753-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist