MEDICARE: DR. MILTON P EHRLICH PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0727	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3K0665	OTHER	NJ	HEALTH NET
2	13033700	OTHER	NJ	MAGELLAN
3	226942	OTHER	NJ	MHN

General Provider Information

NPI Number	:	1215901251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILTON P EHRLICH PHD

Provider Business Mailing Address
First Line	:	199 CHRISTIE
Second Line	:
City	:	LEONIA
State	:	NJ
Zip	:	07605-1901
Country	:	US
Telephone Number	:	201-947-5647
Fax Number	:

Provider Business Practice Location Address
First Line	:	199 CHRISTIE ST
Second Line	:
City	:	LEONIA
State	:	NJ
Zip	:	07605-1901
Country	:	US
Telephone Number	:	201-947-5647
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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