Healthcare Provider Details

I. General information

NPI: 1114518198
Provider Name (Legal Business Name): ERICA PATRICIA DWECK LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 COLIN PL
BROOKLYN NY
11223-2826
US

IV. Provider business mailing address

40 COLIN PL
BROOKLYN NY
11223-2826
US

V. Phone/Fax

Practice location:
  • Phone: 646-734-5681
  • Fax:
Mailing address:
  • Phone: 646-734-5681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006870
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: