Provider Demographics
NPI:1851563076
Name:DAVID POTOKER
Entity Type:Organization
Organization Name:DAVID POTOKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:POTOKER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD CCC-SLP
Authorized Official - Phone:814-459-9700
Mailing Address - Street 1:1611 PEACH ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2109
Mailing Address - Country:US
Mailing Address - Phone:814-459-9700
Mailing Address - Fax:814-454-8728
Practice Address - Street 1:1611 PEACH ST
Practice Address - Street 2:SUITE 290
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2109
Practice Address - Country:US
Practice Address - Phone:814-459-9700
Practice Address - Fax:814-454-8728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL 00129 L261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396582Medicare Oscar/Certification