Provider Demographics
NPI:1811368962
Name:ERCOLANI, ERICA (PA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ERCOLANI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 E AMES CT
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2317
Mailing Address - Country:US
Mailing Address - Phone:516-414-6900
Mailing Address - Fax:516-307-8400
Practice Address - Street 1:200 GARDEN CITY PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3301
Practice Address - Country:US
Practice Address - Phone:516-663-6400
Practice Address - Fax:516-663-6404
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY018896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant