Provider Demographics
NPI:1942207980
Name:BROCKS, ERIC R (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:BROCKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WESTAGE BUSINESS CTR
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2264
Mailing Address - Country:US
Mailing Address - Phone:845-896-9280
Mailing Address - Fax:845-896-0246
Practice Address - Street 1:200 WESTAGE BUSINESS CTR
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2264
Practice Address - Country:US
Practice Address - Phone:845-896-9280
Practice Address - Fax:845-896-0246
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116546207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00398632Medicaid
NY0277170001Medicare NSC
B12362Medicare UPIN
NY180009974Medicare PIN
290461Medicare ID - Type Unspecified