Provider Demographics
NPI:1942367230
Name:NIEDRITIS, ERIK ALVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:ALVIS
Last Name:NIEDRITIS
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 1:35 SEAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3131
Mailing Address - Country:US
Mailing Address - Phone:516-678-2487
Mailing Address - Fax:516-678-2487
Practice Address - Street 1:35 SEAMAN AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3131
Practice Address - Country:US
Practice Address - Phone:516-678-2487
Practice Address - Fax:516-766-7535
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01077398Medicaid
NY01077398Medicaid
NYA61049Medicare UPIN