Provider Demographics
NPI:1962789933
Name:JOSH C EHRLICH DPM PC
Entity type:Organization
Organization Name:JOSH C EHRLICH DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-295-4898
Mailing Address - Street 1:260 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1720
Mailing Address - Country:US
Mailing Address - Phone:516-295-4898
Mailing Address - Fax:718-336-5375
Practice Address - Street 1:1535 51ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3738
Practice Address - Country:US
Practice Address - Phone:718-436-8886
Practice Address - Fax:718-436-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004077261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00969104Medicaid
NY00969104Medicaid