Provider Demographics
NPI:1366840142
Name:IPPOLITO, ERIKA (CRNA)
Entity type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:
Last Name:IPPOLITO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:IPPOLITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:
Practice Address - Street 1:270-05 76TH AVENUE
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-0000
Practice Address - Country:US
Practice Address - Phone:718-470-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602979367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered