1659329688 NPI number — BRIAN S EHRLICH M.D.

Table of content: BRIAN S EHRLICH M.D. (NPI 1659329688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659329688 NPI number — BRIAN S EHRLICH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EHRLICH
Provider First Name:
BRIAN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659329688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 PARKWAY SOUTH
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-443-4383
Provider Business Mailing Address Fax Number:
860-443-3980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 PARKWAY SOUTH
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-443-4383
Provider Business Practice Location Address Fax Number:
860-443-3980
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  21381 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0V9734 . This is a "HELATHNET/ECCD:06-1616101" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2523176 . This is a "OXFORD/ECCD: 06-1616101" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001213818 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06-1616101 . This is a "COMM. HEALTH NETWORK/ECCD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010021381CT01 . This is a "ANTHEM/ECCG:06-1049086" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010021381CT04 . This is a "ANTHEM/ECCD:06-1616101" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06-1616101 . This is a "UNITEDHEALTHCARE/ECCD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060064821 . This is a "RR MED/ECCD: 06-1616101" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001213818 . This is a "BLUECARE FAMILY PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 021381 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 030250 . This is a "HEALTHNET/ECCG:06-1049086" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06-1049086 . This is a "COMM. HEALTH NETWORK/ECCG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06-1049086 . This is a "UNITEDHEALTHCARE/ECCG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500HBC444CT01 . This is a "ANTHEM/HOSP-BASED ECCD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060014259 . This is a "RR MED/ECCG: 06-1049086" identifier . This identifiers is of the category "OTHER".
  • Identifier: NLS102 . This is a "OXFORD /ECCG: 06-1049086" identifier . This identifiers is of the category "OTHER".




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