Provider Demographics
NPI:1841230059
Name:NIELSEN, ERIN (PT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0212
Mailing Address - Country:US
Mailing Address - Phone:585-582-1330
Mailing Address - Fax:585-582-2537
Practice Address - Street 1:20 ASSEMBLY DR STE 101
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:NY
Practice Address - Zip Code:14506-9609
Practice Address - Country:US
Practice Address - Phone:585-582-1330
Practice Address - Fax:585-582-2537
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0018001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP0140059WHOtherBLUE CHOICE
NYFA0501OtherPREFERRED CARE
NYFA0501OtherPREFERRED CARE