Provider Demographics
NPI:1982759445
Name:ERICKSON, ERIC NILS JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:NILS
Last Name:ERICKSON
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NIGHTINGALE RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-3004
Mailing Address - Country:US
Mailing Address - Phone:908-459-5848
Mailing Address - Fax:
Practice Address - Street 1:400 LANGLEY ROAD
Practice Address - Street 2:177TH MEDICAL GROUP
Practice Address - City:EGG HARBOR TWSP
Practice Address - State:NJ
Practice Address - Zip Code:08234
Practice Address - Country:US
Practice Address - Phone:609-645-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP00499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant