Healthcare Provider Details

I. General information

NPI: 1629352828
Provider Name (Legal Business Name): ERIN GROGAN DEEB P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 RT 9W
WEST COXSACKIE NY
12192-3605
US

IV. Provider business mailing address

1205 TROY SCHENECTADY RD STE 101
LATHAM NY
12110-1074
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-9000
  • Fax: 518-731-9119
Mailing address:
  • Phone: 518-348-3176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberP81729
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: