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General NPI Number Information
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NPI Number | 1043287006
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Entity Type | Individual
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Provider Name | ERIKA M JURASITS D.O
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Gender | Female
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 170 N COUNTRY RD STE 2
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2606
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Country | US
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Telephone | 631-509-6888
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Fax | 631-509-6895
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Provider Business Mailing Address
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Address Line | 4 HIGH CT
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City | MOUNT SINAI
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State | NY
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Zip | 11766-1204
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Country | US
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Telephone | 631-509-6888
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Fax | 631-509-6895
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 210112
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License Number State | NY
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