Provider Demographics
NPI:1881716934
Name:ERIKSEN, ROY H (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:H
Last Name:ERIKSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1627
Mailing Address - Country:US
Mailing Address - Phone:845-358-5006
Mailing Address - Fax:845-358-4340
Practice Address - Street 1:311 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1627
Practice Address - Country:US
Practice Address - Phone:845-358-5006
Practice Address - Fax:845-358-4340
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00225163Medicaid
NY00225163Medicaid
NYC11844Medicare UPIN