Provider Demographics
NPI:1831667286
Name:FICHERA, ERIC PAUL (DPT)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:FICHERA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3111
Mailing Address - Country:US
Mailing Address - Phone:718-208-6002
Mailing Address - Fax:718-351-7693
Practice Address - Street 1:31 NEW DORP LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2351
Practice Address - Country:US
Practice Address - Phone:718-979-4466
Practice Address - Fax:718-979-5236
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-04
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist