MEDICARE: ERICA ISRAEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1316469398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA ISRAEL

Provider Business Mailing Address
First Line	:	200 BEACH 139TH ST
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-1214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 BEACH 139TH ST
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-1214
Country	:	US
Telephone Number	:	917-669-6554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	07/12/2017

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Directions to “ ERICA ISRAEL ” Practice Location

Language	Start Address	Practice Location

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