Provider Demographics
NPI:1730182403
Name:ERLICHMAN, MICHAEL C (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:ERLICHMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ROLLING VIEWS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-754-2050
Mailing Address - Fax:973-754-2633
Practice Address - Street 1:703 MAIN STREET
Practice Address - Street 2:ST. JOSEPH'S REGIONAL MEDICAL CENTER
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503
Practice Address - Country:US
Practice Address - Phone:973-754-2050
Practice Address - Fax:973-754-2633
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ102781223S0112X
NY304701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ER520792Medicare ID - Type Unspecified
U24791Medicare UPIN