MEDICARE: EDITA ERLIKH MS

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	174400000X	Specialist	1270300	NY

General Provider Information

NPI Number	:	1245648674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITA ERLIKH MS

Provider Business Mailing Address
First Line	:	800 OCEAN PKWY
Second Line	:	APT 6J
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2185
Country	:	US
Telephone Number	:	347-262-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 OCEAN PKWY
Second Line	:	APT 6J
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2185
Country	:	US
Telephone Number	:	347-262-0500
Fax Number	:

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

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	09/18/2014

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