Provider Demographics
NPI:1588727853
Name:ERB, VANESSA (PA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ERB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2605
Mailing Address - Country:US
Mailing Address - Phone:631-654-3424
Mailing Address - Fax:
Practice Address - Street 1:101 NICHOLLS ROAD HEALTH SCIENCES TOWER LEVEL 16 RM 020
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2366
Practice Address - Country:US
Practice Address - Phone:631-444-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant