Basic Information
Provider Information
NPI: 1033556345
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCMAHON
FirstName: ERIN
MiddleName:  
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X NYY Other Service ProvidersCase Manager/Care Coordinator 

ID Information
IDTypeStateIssuerDescription
REG2081611-578416C301NYNY STATE DEPT OF HEALTH BUREAU OF EARLY INTERVENTIONOTHER


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