Provider Demographics
NPI:1255737938
Name:ALTI, ERICA LAUREN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LAUREN
Last Name:ALTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2345
Mailing Address - Country:US
Mailing Address - Phone:516-779-7701
Mailing Address - Fax:
Practice Address - Street 1:113 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2345
Practice Address - Country:US
Practice Address - Phone:516-779-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1172056174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist