Healthcare Provider Details

I. General information

NPI: 1508793316
Provider Name (Legal Business Name): MARYANA EBRAHEEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 OLD FARM RD
LEVITTOWN NY
11756-1526
US

IV. Provider business mailing address

66 OLD FARM RD
LEVITTOWN NY
11756-1526
US

V. Phone/Fax

Practice location:
  • Phone: 917-732-6754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: