Provider Demographics
NPI:1487924148
Name:ADLER, ERICA STACI
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:STACI
Last Name:ADLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:STACI
Other - Last Name:ADLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSED
Mailing Address - Street 1:2200 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-655-9576
Mailing Address - Fax:
Practice Address - Street 1:2200 3RD ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1810
Practice Address - Country:US
Practice Address - Phone:516-655-9576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor