Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 263030 | NY |
N | 207R00000X | Internist | MT188426 | PA |
N | 111NI0900X | Internist | MT188426 | PA |
NPI | 1144433830 |
---|---|
Provider Name | Erin Banta |
First Address | New York, NY 10005-2178 |
Second Address | Mineola, NY 11501-4077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 06/10/2021 |