Provider Demographics
NPI:1568617645
Name:EHRMAN, LUIS J SR (ANP-C)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:J
Last Name:EHRMAN
Suffix:SR
Gender:M
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3012
Mailing Address - Country:US
Mailing Address - Phone:631-790-1239
Mailing Address - Fax:
Practice Address - Street 1:22 MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3012
Practice Address - Country:US
Practice Address - Phone:631-476-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304949363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health