MEDICARE: JOAN EHRLICH MSED

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		NY

General Provider Information

NPI Number	:	1891058541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN EHRLICH MSED

Provider Business Mailing Address
First Line	:	125 BAY 34TH ST
Second Line	:	1R
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5254
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 BAY 34TH ST
Second Line	:	1R
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5254
Country	:	US
Telephone Number	:	917-468-9591
Fax Number	:

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

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	07/21/2022

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