Healthcare Provider Details

I. General information

NPI: 1770946147
Provider Name (Legal Business Name): ERICA JANE FAGELMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L. LEVY PLACE ANESTHESIOLOGY DEPARTMENT OF MOUNT SINAI
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

PO BOX 28082
NEW YORK NY
10087-5024
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6426
  • Fax: 212-876-3906
Mailing address:
  • Phone: 212-987-3100
  • Fax: 412-937-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number303700
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: