Individual provider Active NPI

Shira Ehrlich, PA

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1679129068
Registry record updated Aug 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
021325 Issued in NY
Practice address
2820 Ocean Pkwy
Brooklyn, NY 11235-7903
Phone
(718) 996-3000
NPI assigned
Aug 13, 2019
Last updated
Aug 13, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 021325 NY Primary

Addresses

Primary practice location

2820 Ocean Pkwy
Brooklyn, NY 11235-7903

Mailing address

6715 102ND St Apt 5T
Forest Hills, NY 11375-2414
Phone (516) 660-6287

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200214001162 NY Practitioner - Physician Assistant 7214363076 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Dermatology PCGroup PAC ID 3274526850, 67 clinicians

Practice addresses (Care Compare)

10460 Queens Blvd
Suite 1C
Forest Hills, NY 11375-7301
Phone (718) 275-5555

1078 Oaks Dr
FL 2
Franklin Square, NY 11010-1941
Phone (516) 834-2500

175 I U Willets Rd
Suite 2
Albertson, NY 11507-1342
Phone (516) 625-6222

4 Technology Dr
Suite 180
East Setauket, NY 11733-4068
Phone (631) 689-3188

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
021325NYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Howard D. Solomon, DO, PC Past Accepting new patients
Anthony Buglino DO PLLC Past Accepting new patients
Richard S. Berry MDPC PastSince Aug 18, 2019 Accepting new patients

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: serlich@advderm.emadirect.md

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565654400000",
    "number": "1679129068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6715 102ND ST APT 5T",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752414",
            "telephone_number": "516-660-6287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 OCEAN PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112357903",
            "telephone_number": "718-996-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHRLICH",
        "first_name": "SHIRA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-13",
        "last_updated": "2019-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "021325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.