Healthcare Provider Details

I. General information

NPI: 1700946746
Provider Name (Legal Business Name): ERICA P CELESTINE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 COATES DR SUITE 4
GOSHEN NY
10924-6748
US

IV. Provider business mailing address

27 THOMPSON ST
RED HOOK NY
12571-1701
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-8831
  • Fax: 845-294-1180
Mailing address:
  • Phone: 845-633-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number007824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: