MEDICARE: MS. ERICA LANE

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	00000000

General Provider Information

NPI Number	:	1942755897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA LANE

Provider Business Mailing Address
First Line	:	2332 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5002
Country	:	US
Telephone Number	:	404-414-1546
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5002
Country	:	US
Telephone Number	:	404-414-1546
Fax Number	:

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

Provider Enumeration Date	:	08/22/2016
Last Update Date	:	08/22/2016

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Directions to “ MS. ERICA LANE ” Practice Location

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