Healthcare Provider Details

I. General information

NPI: 1164004370
Provider Name (Legal Business Name): MR. ERICK DREHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 ROUTE 112 STE 10
MEDFORD NY
11763-1411
US

IV. Provider business mailing address

3253 ROUTE 112 STE 10
MEDFORD NY
11763-1411
US

V. Phone/Fax

Practice location:
  • Phone: 631-880-7929
  • Fax:
Mailing address:
  • Phone: 631-880-7929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number078589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: