Provider Demographics
NPI:1003828039
Name:ERMOLENKO, GUERMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GUERMAN
Middle Name:
Last Name:ERMOLENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NEW KARNER RD
Mailing Address - Street 2:#627
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-6200
Mailing Address - Country:US
Mailing Address - Phone:518-229-0807
Mailing Address - Fax:866-465-2338
Practice Address - Street 1:11 NEW KARNER RD
Practice Address - Street 2:#627
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-6200
Practice Address - Country:US
Practice Address - Phone:518-229-0807
Practice Address - Fax:866-465-2338
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2147652084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400003470OtherNGS MEDICARE PIN
NYG76834Medicare UPIN