Provider Demographics
NPI:1124249644
Name:EHRENREICH, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:EHRENREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MILLBURN AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1945
Mailing Address - Country:US
Mailing Address - Phone:973-763-7546
Mailing Address - Fax:
Practice Address - Street 1:90 MILLBURN AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1945
Practice Address - Country:US
Practice Address - Phone:973-763-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08503900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology