Healthcare Provider Details

I. General information

NPI: 1740143916
Provider Name (Legal Business Name): ERYKA PESKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 N 28TH ST
BOISE ID
83703-5609
US

IV. Provider business mailing address

2319 N 28TH ST
BOISE ID
83703-5609
US

V. Phone/Fax

Practice location:
  • Phone: 917-822-8953
  • Fax:
Mailing address:
  • Phone: 917-822-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-38950
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number075073
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: