Provider Demographics
NPI:1487486080
Name:ERLICH, ELEANOR HANNA
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:HANNA
Last Name:ERLICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 BAY RD APT 317
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3233
Mailing Address - Country:US
Mailing Address - Phone:201-655-1618
Mailing Address - Fax:
Practice Address - Street 1:1508 BAY RD APT 317
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3233
Practice Address - Country:US
Practice Address - Phone:201-655-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86167834133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered