Provider Demographics
NPI:1104170521
Name:DODDS, ERICA ANN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:DODDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CONEY ISLAND AVE. 4TH FL
Mailing Address - Street 2:STEP UP THERAPY BROOKLYN NY 11230 4TH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:718-434-1200
Mailing Address - Fax:718-434-1099
Practice Address - Street 1:1100 CONEY ISLAND AVE.
Practice Address - Street 2:STEP UP THERAPY BROOKLYN NY 4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:718-434-1200
Practice Address - Fax:718-434-1099
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114895851174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator