Basic Information
| Provider Information | |||||||||
| NPI: | 1033556345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMAHON | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 W GLANN RD | ||||||||
| Address2: | |||||||||
| City: | APALACHIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137324026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 6076254251 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 W GLANN RD | ||||||||
| Address2: | |||||||||
| City: | APALACHIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137324026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072228977 | ||||||||
| FaxNumber: | 6076254251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2013 | ||||||||
| LastUpdateDate: | 05/28/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | NY | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | REG2081611-578416C3 | 01 | NY | NY STATE DEPT OF HEALTH BUREAU OF EARLY INTERVENTION | OTHER |