Healthcare Provider Details

I. General information

NPI: 1255971206
Provider Name (Legal Business Name): ERIKA DIKLICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MELROSE AVE STE 2L
BRONX NY
10451-4443
US

IV. Provider business mailing address

3213 82ND ST
EAST ELMHURST NY
11370-2003
US

V. Phone/Fax

Practice location:
  • Phone: 917-473-6996
  • Fax:
Mailing address:
  • Phone: 347-403-2859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number782081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: