Healthcare Provider Details

I. General information

NPI: 1104671916
Provider Name (Legal Business Name): ERICA KREPOSTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 MERMAID AVE
BROOKLYN NY
11224-2092
US

IV. Provider business mailing address

2819 MERMAID AVE
BROOKLYN NY
11224-2092
US

V. Phone/Fax

Practice location:
  • Phone: 718-265-6066
  • Fax: 718-265-0665
Mailing address:
  • Phone: 718-265-6066
  • Fax: 718-265-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: