Provider Demographics
NPI:1194088328
Name:EHRLICH, ELANA M
Entity type:Individual
Prefix:
First Name:ELANA
Middle Name:M
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BENTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5402
Mailing Address - Country:US
Mailing Address - Phone:516-448-8336
Mailing Address - Fax:
Practice Address - Street 1:100 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2818
Practice Address - Country:US
Practice Address - Phone:516-448-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist