Healthcare Provider Details

I. General information

NPI: 1003620782
Provider Name (Legal Business Name): ERICA GABRIELLE LALOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GLEN ST STE 214
GLEN COVE NY
11542-2701
US

IV. Provider business mailing address

830 MADISON ST APT 232
HOBOKEN NJ
07030-6497
US

V. Phone/Fax

Practice location:
  • Phone: 917-509-3379
  • Fax:
Mailing address:
  • Phone: 732-614-4581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131899
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: