Healthcare Provider Details

I. General information

NPI: 1639240278
Provider Name (Legal Business Name): ERIKA CONNOR, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAIN ST
RANDOLPH NY
14772-1131
US

IV. Provider business mailing address

111 MAIN ST
RANDOLPH NY
14772-1131
US

V. Phone/Fax

Practice location:
  • Phone: 716-358-2340
  • Fax: 716-358-2350
Mailing address:
  • Phone: 716-358-2340
  • Fax: 716-358-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number172279
License Number StateNY

VIII. Authorized Official

Name: ERIKA CONNOR
Title or Position: PRESIDENT
Credential:
Phone: 716-358-2340