Healthcare Provider Details

I. General information

NPI: 1629817697
Provider Name (Legal Business Name): ERIC ROBERT STROMBACH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 MERRICK RD
MASSAPEQUA NY
11758-6238
US

IV. Provider business mailing address

1 MONACO CT
RONKONKOMA NY
11779-4596
US

V. Phone/Fax

Practice location:
  • Phone: 631-673-3233
  • Fax:
Mailing address:
  • Phone: 631-889-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104215
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: