MEDICARE: ERICA ERCOLANI PA

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
1	363A00000X	Physician Assistant	018896	NY

General Provider Information

NPI Number	:	1811368962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA ERCOLANI PA

Provider Business Mailing Address
First Line	:	264 SILLS RD
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-8804
Country	:	US
Telephone Number	:	631-504-6261
Fax Number	:	631-277-0978

Provider Business Practice Location Address
First Line	:	264 SILLS RD
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-8804
Country	:	US
Telephone Number	:	631-504-6261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	03/04/2026

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