MEDICARE: DR. WILLIAM LEIF ERICKSEN MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	304634	NY

General Provider Information

NPI Number	:	1821446402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM LEIF ERICKSEN MD

Provider Business Mailing Address
First Line	:	33 LEWIS RD
Second Line	:	2ND FL
City	:	BINGHAMTON
State	:	NY
Zip	:	13905
Country	:	US
Telephone Number	:	607-770-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 CORLISS AVE APT 107
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2071
Country	:	US
Telephone Number	:	607-763-6735
Fax Number	:	607-763-6736

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

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	06/28/2021

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