Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X008754-1 | NY |
NPI | 1043375603 |
---|---|
Provider Name | Dr. Kenneth John Erickson |
First Address | Jamestown, NY 14701 |
Second Address | Jamestown, NY 14701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 02/03/2015 |