Provider Demographics
NPI:1447335328
Name:MAGER, ERIC S (MD,FACS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:MAGER
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5204
Mailing Address - Country:US
Mailing Address - Phone:516-466-7000
Mailing Address - Fax:
Practice Address - Street 1:650 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5204
Practice Address - Country:US
Practice Address - Phone:516-466-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG96218Medicare UPIN
NYEM039L410Medicare ID - Type Unspecified