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NPI Code Detail

MEDICARE: MR. ERIC D. DRYJA LCSWR

MEDICARE: MR. ERIC D. DRYJA LCSWR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker078395NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1160743251-47OTHERNYPRISM
200030241501OTHERNYUNIVERA

General Provider Information

NPI Number : 1588628267
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC D. DRYJA LCSWR
Provider Business Mailing Address
First Line : 227 THORN AVE
Second Line :
City : ORCHARD PARK
State : NY
Zip : 14127-2600
Country : US
Telephone Number : 716-662-2040
Fax Number : 716-662-0019
Provider Business Practice Location Address
First Line : 34 N MAIN ST
Second Line :
City : WARSAW
State : NY
Zip : 14569-1326
Country : US
Telephone Number : 585-786-0220
Fax Number : 585-786-3631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2006
Last Update Date : 09/20/2011

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