Provider Demographics
NPI:1962616649
Name:MENESES, ERIC JOHN (LPN)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JOHN
Last Name:MENESES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VICTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4530
Mailing Address - Country:US
Mailing Address - Phone:631-714-4959
Mailing Address - Fax:
Practice Address - Street 1:15 VICTORIA CIR
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4530
Practice Address - Country:US
Practice Address - Phone:631-714-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01898695Medicaid