Provider Demographics
NPI:1861477820
Name:ENTIN, ERIK JON (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:JON
Last Name:ENTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:824 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4950
Mailing Address - Country:US
Mailing Address - Phone:516-822-2230
Mailing Address - Fax:516-822-0163
Practice Address - Street 1:824 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4950
Practice Address - Country:US
Practice Address - Phone:516-822-2230
Practice Address - Fax:516-822-0163
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1200222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY683081OtherEMPRIE BLUE CROSS
NYAS409OtherOXFORD
NY0093476OtherAETNA USHC
NY00397099Medicaid
NY0399280-011OtherCIGNA
NY42047256OtherAETNA
NY593340OtherUNITED HEALTHCARE
NYB17952Medicare UPIN
NY00397099Medicaid