Healthcare Provider Details

I. General information

NPI: 1053359893
Provider Name (Legal Business Name): CONRAD PAUL EHRLICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 SAND PIT RD STE 105 HOUSATONIC VALLEY RADIOLOGICAL ASSOC. PC
DANBURY CT
06810-4032
US

IV. Provider business mailing address

67 SAND PIT RD NORTHEAST RADIOLOGY
DANBURY CT
06810-4032
US

V. Phone/Fax

Practice location:
  • Phone: 203-797-1770
  • Fax: 203-796-7839
Mailing address:
  • Phone: 203-797-1770
  • Fax: 845-278-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number025510
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number025510
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: