Healthcare Provider Details

I. General information

NPI: 1093479156
Provider Name (Legal Business Name): ERIKA BARBARA VIGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SOUTH AVE
STATEN ISLAND NY
10314-3403
US

IV. Provider business mailing address

119 ELIZABETH ST
STATEN ISLAND NY
10310-2323
US

V. Phone/Fax

Practice location:
  • Phone: 718-556-1616
  • Fax: 718-442-9962
Mailing address:
  • Phone: 718-981-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: