Individual
MS. BRIENNE JAMIE ERB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23 HARVEY LANE, LAKE RONKONKOMA, NY 11779
(631) 742-2681
Mailing address
23 HARVEY LANE, LAKE RONKONKOMA, NY 11779
(631) 742-2681
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1858888
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174400000X
TEACHER
NY
Enumeration date
08/31/2012
Last updated
08/31/2012
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