Provider Demographics
NPI:1073630026
Name:EHRLICH, PHYLLIS L
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:L
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6434 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1507
Mailing Address - Country:US
Mailing Address - Phone:215-483-1107
Mailing Address - Fax:215-509-6737
Practice Address - Street 1:12265 TOWNSEND RD
Practice Address - Street 2:SUITE 400
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19154-1201
Practice Address - Country:US
Practice Address - Phone:215-856-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000030L171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor