Provider Demographics
NPI:1891724779
Name:ERENSHTEYN, ZHANNA (DPM)
Entity Type:Individual
Prefix:
First Name:ZHANNA
Middle Name:
Last Name:ERENSHTEYN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 ENGLE ST
Mailing Address - Street 2:J4
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2427
Mailing Address - Country:US
Mailing Address - Phone:201-541-1422
Mailing Address - Fax:
Practice Address - Street 1:275 ENGLE ST
Practice Address - Street 2:J4
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2427
Practice Address - Country:US
Practice Address - Phone:201-541-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00274100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0011819Medicaid
NJ0011819Medicaid