Healthcare Provider Details

I. General information

NPI: 1861477820
Provider Name (Legal Business Name): ERIK JON ENTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 OLD COUNTRY RD
PLAINVIEW NY
11803-4950
US

IV. Provider business mailing address

824 OLD COUNTRY RD
PLAINVIEW NY
11803-4950
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-2230
  • Fax: 516-822-0163
Mailing address:
  • Phone: 516-822-2230
  • Fax: 516-822-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number120022
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier683081
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerEMPRIE BLUE CROSS
# 2
IdentifierAS409
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerOXFORD
# 3
Identifier0093476
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerAETNA USHC
# 4
Identifier00397099
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 5
Identifier0399280-011
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerCIGNA
# 6
Identifier42047256
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerAETNA
# 7
Identifier593340
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUNITED HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: