Provider Demographics
NPI:1538119169
Name:ERICKSON, ALAN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
Last Name:ERICKSON
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 1:1206 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2414
Mailing Address - Country:US
Mailing Address - Phone:609-597-8087
Mailing Address - Fax:
Practice Address - Street 1:1206 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2414
Practice Address - Country:US
Practice Address - Phone:609-597-8087
Practice Address - Fax:609-597-7192
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04224600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2531305Medicaid
NJ404558Medicare ID - Type Unspecified
NJC58526Medicare UPIN