Provider Demographics
NPI:1336401421
Name:GULYAKO, ERIK M
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:M
Last Name:GULYAKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 BRIGHTON 2ND ST
Mailing Address - Street 2:APT 1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7535
Mailing Address - Country:US
Mailing Address - Phone:347-372-3520
Mailing Address - Fax:
Practice Address - Street 1:2163 E 7TH ST
Practice Address - Street 2:#A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4933
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY551655111103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst