Healthcare Provider Details

I. General information

NPI: 1770148702
Provider Name (Legal Business Name): ERIK MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 38TH ST RM 817
NEW YORK NY
10018-3541
US

IV. Provider business mailing address

2179 STEINWAY ST APT 2A
ASTORIA NY
11105-1830
US

V. Phone/Fax

Practice location:
  • Phone: 212-695-4564
  • Fax:
Mailing address:
  • Phone: 917-291-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: