Provider Demographics
NPI:1053902999
Name:FEENEY, ERIN ROSE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ROSE
Last Name:FEENEY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 HALF MOON DR
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413-2513
Mailing Address - Country:US
Mailing Address - Phone:518-965-3331
Mailing Address - Fax:
Practice Address - Street 1:222 HALF MOON DR
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-2513
Practice Address - Country:US
Practice Address - Phone:518-965-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant