MEDICARE: ALEXANDRA EBOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	26NR19457000	NJ

General Provider Information

NPI Number	:	1760344618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA EBOL

Provider Business Mailing Address
First Line	:	300 E 66TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E 66TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6800
Country	:	US
Telephone Number	:	646-888-6898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ ALEXANDRA EBOL ” Practice Location

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