Provider Demographics
NPI:1730788464
Name:ERMLICH-BENJAMIN, NICOLE L
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:L
Last Name:ERMLICH-BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:ERMLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:288 AFTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:NY
Mailing Address - Zip Code:13730-2216
Mailing Address - Country:US
Mailing Address - Phone:607-644-4085
Mailing Address - Fax:
Practice Address - Street 1:151 HELEN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-3437
Practice Address - Country:US
Practice Address - Phone:607-763-8432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist