Healthcare Provider Details

I. General information

NPI: 1275697450
Provider Name (Legal Business Name): ERIE NEUROSURGERY & ASSOC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 TYLER ST SUITE 350
SANDUSKY OH
44870-3367
US

IV. Provider business mailing address

703 TYLER ST SUITE 350
SANDUSKY OH
44870-3367
US

V. Phone/Fax

Practice location:
  • Phone: 419-626-7070
  • Fax: 419-609-0795
Mailing address:
  • Phone: 419-626-7070
  • Fax: 419-609-0795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICENTA C GASPAR-YOO
Title or Position: PRACTICE ADMINISTRATOR
Credential: M.D.
Phone: 419-626-7070