Provider Demographics
NPI:1912980053
Name:ERALI, RICHARD PEARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PEARL
Last Name:ERALI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LANSING ST
Mailing Address - Street 2:AUBURN MEMORIAL MEDICAL SERVICES, PC
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-567-0455
Mailing Address - Fax:315-255-7099
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1944
Practice Address - Country:US
Practice Address - Phone:315-252-7559
Practice Address - Fax:315-253-8104
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM197213ES0103X
NYN006001-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03288442Medicaid
TN3350748Medicaid
NYJ400026597Medicare PIN
TN3350748Medicare ID - Type Unspecified
TN3350748Medicaid