Provider Demographics
NPI:1689800633
Name:THOMAS P. ERHART DO PC
Entity Type:Organization
Organization Name:THOMAS P. ERHART DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:ERHART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-474-4917
Mailing Address - Street 1:1500 ROUTE 112
Mailing Address - Street 2:BLDG 11, SUITE B
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3060
Mailing Address - Country:US
Mailing Address - Phone:631-474-4917
Mailing Address - Fax:631-331-1048
Practice Address - Street 1:1500 ROUTE 112
Practice Address - Street 2:BLDG 11, SUITE B
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3060
Practice Address - Country:US
Practice Address - Phone:631-474-4917
Practice Address - Fax:631-331-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193070207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF76013Medicare UPIN
NY48G533Medicare PIN