Provider Demographics
NPI:1346297611
Name:EHRLICH, JERRY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:S
Last Name:EHRLICH
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 1:1999 MARLTON PIKE E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1825
Mailing Address - Country:US
Mailing Address - Phone:856-424-2485
Mailing Address - Fax:856-424-3885
Practice Address - Street 1:1999 MARLTON PIKE E
Practice Address - Street 2:SUITE 3
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1825
Practice Address - Country:US
Practice Address - Phone:856-424-2485
Practice Address - Fax:856-424-3885
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA020177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE53037Medicare UPIN