Provider Demographics
NPI:1457551335
Name:NASSIF, ERIK J (PT)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:J
Last Name:NASSIF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 WALTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-478-0380
Mailing Address - Fax:315-478-0388
Practice Address - Street 1:419 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1925
Practice Address - Country:US
Practice Address - Phone:315-717-0278
Practice Address - Fax:315-717-0280
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA0171OtherGRP MCR
AA0172OtherGRP MEDICARE #
AA0171OtherGRP MCR
AA0172OtherGRP MEDICARE #