Healthcare Provider Details

I. General information

NPI: 1740063882
Provider Name (Legal Business Name): ENS PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

4209 URN ST
CAPITOL HEIGHTS MD
20743-5662
US

V. Phone/Fax

Practice location:
  • Phone: 330-396-0698
  • Fax:
Mailing address:
  • Phone: 234-759-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ETHAN NATHANIEL SALES
Title or Position: PSYCHIATRIST
Credential:
Phone: 330-396-0698