1902826837 NPI number — MS. EILEEN ERSTENIUK CSWR

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902826837 NPI number — MS. EILEEN ERSTENIUK CSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERSTENIUK
Provider First Name:
EILEEN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CSWR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANNAN
Provider Other First Name:
EILEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902826837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1519 NYE RD
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
LYONS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14489-9112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-946-5722
Provider Business Mailing Address Fax Number:
315-946-5726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1202 DRIVING PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14513-1086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-331-2030
Provider Business Practice Location Address Fax Number:
315-331-4529
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  0301071 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD449P . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010030107 . This is a "BLUE CHOICE & CHILD HLTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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