Healthcare Provider Details

I. General information

NPI: 1003725235
Provider Name (Legal Business Name): ERICA TEJADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W 113TH ST
NEW YORK NY
10026-3306
US

IV. Provider business mailing address

239 W 105TH ST APT 4
NEW YORK NY
10025-3922
US

V. Phone/Fax

Practice location:
  • Phone: 212-678-2898
  • Fax:
Mailing address:
  • Phone: 310-701-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number038007-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: