Healthcare Provider Details

I. General information

NPI: 1306740006
Provider Name (Legal Business Name): ERIN TIERNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

994 W JERICHO TPKE
SMITHTOWN NY
11787-3235
US

IV. Provider business mailing address

33 ALHAMBRA RD
MASSAPEQUA NY
11758-6603
US

V. Phone/Fax

Practice location:
  • Phone: 631-543-1440
  • Fax:
Mailing address:
  • Phone: 631-543-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1250276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: