Provider Demographics
NPI:1972974475
Name:ERICK, DOBGIMA (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:DOBGIMA
Middle Name:
Last Name:ERICK
Suffix:
Gender:M
Credentials:DNP, FNP-BC
Other - Prefix:DR
Other - First Name:DOBGIMA
Other - Middle Name:
Other - Last Name:ERICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-BC,PMHNP-BC
Mailing Address - Street 1:405 W 238TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2208
Mailing Address - Country:US
Mailing Address - Phone:845-605-8045
Mailing Address - Fax:992-245-9122
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3477
Practice Address - Country:US
Practice Address - Phone:914-666-1200
Practice Address - Fax:914-666-1976
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY668798163W00000X
NY340537363LF0000X
NY402889363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04536325Medicaid