Provider Demographics
NPI:1528381175
Name:EHRENBERG, ALAN
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:EHRENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7608
Mailing Address - Country:US
Mailing Address - Phone:718-384-7334
Mailing Address - Fax:718-599-5155
Practice Address - Street 1:572 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7608
Practice Address - Country:US
Practice Address - Phone:718-384-7334
Practice Address - Fax:718-599-5155
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist