Provider Demographics
NPI:1700946746
Name:CELESTINE, ERICA P (PA)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:P
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1701
Mailing Address - Country:US
Mailing Address - Phone:845-633-3022
Mailing Address - Fax:
Practice Address - Street 1:7 COATES DR
Practice Address - Street 2:SUITE 4
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6748
Practice Address - Country:US
Practice Address - Phone:845-294-8831
Practice Address - Fax:845-294-1180
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007824363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant