Basic Information
Provider Information
NPI: 1053833723
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ERPS
FirstName: YECHIEL
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8 ROMAN BLVD
Address2:  
City: MONSEY
State: NY
PostalCode: 109523107
CountryCode: US
TelephoneNumber: 8455216782
FaxNumber:  
Practice Location
Address1: 1651 CONEY ISLAND AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112305849
CountryCode: US
TelephoneNumber: 7189981415
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/13/2017
LastUpdateDate: 07/13/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X NYY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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