Healthcare Provider Details

I. General information

NPI: 1356915987
Provider Name (Legal Business Name): ERIK COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 30TH AVE STE 200
ASTORIA NY
11102-2193
US

IV. Provider business mailing address

162 SEQUOIA DR
CORAM NY
11727-2051
US

V. Phone/Fax

Practice location:
  • Phone: 212-707-8222
  • Fax:
Mailing address:
  • Phone: 347-731-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403206-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberF403206-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: