Provider Demographics
NPI:1609859123
Name:EHRENHAUS, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:EHRENHAUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4402 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3041
Mailing Address - Country:US
Mailing Address - Phone:718-428-8400
Mailing Address - Fax:718-428-8405
Practice Address - Street 1:4402 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3041
Practice Address - Country:US
Practice Address - Phone:718-428-8400
Practice Address - Fax:718-428-8405
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2011-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY219684-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02201150Medicaid
NY514A11Medicare ID - Type Unspecified
NY02201150Medicaid