Healthcare Provider Details

I. General information

NPI: 1902394216
Provider Name (Legal Business Name): EZRA SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E 110TH ST UNIT 143
NEW YORK NY
10029-9602
US

IV. Provider business mailing address

153 E 110TH ST UNIT 143
NEW YORK NY
10029-9602
US

V. Phone/Fax

Practice location:
  • Phone: 929-900-6145
  • Fax:
Mailing address:
  • Phone: 929-900-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JASMINE GUTIERREZ
Title or Position: OWNER
Credential:
Phone: 347-668-7159