Provider Demographics
NPI:1013152131
Name:PADOL, ERIC (PSYD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:PADOL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 271
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1801
Mailing Address - Country:US
Mailing Address - Phone:800-725-6280
Mailing Address - Fax:800-725-6380
Practice Address - Street 1:185 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3102
Practice Address - Country:US
Practice Address - Phone:914-966-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017866103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical