Provider Demographics
NPI:1245648674
Name:ERLIKH, EDITA (MS)
Entity type:Individual
Prefix:
First Name:EDITA
Middle Name:
Last Name:ERLIKH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OCEAN PKWY
Mailing Address - Street 2:APT 6J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2185
Mailing Address - Country:US
Mailing Address - Phone:347-262-0500
Mailing Address - Fax:
Practice Address - Street 1:800 OCEAN PKWY
Practice Address - Street 2:APT 6J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2185
Practice Address - Country:US
Practice Address - Phone:347-262-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1270300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist