Healthcare Provider Details

I. General information

NPI: 1871551333
Provider Name (Legal Business Name): RAYMOND L EBARB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MONTAUK HWY
WEST SAYVILLE NY
11796-1800
US

IV. Provider business mailing address

213 MONTAUK HWY
WEST SAYVILLE NY
11796-1800
US

V. Phone/Fax

Practice location:
  • Phone: 631-563-6205
  • Fax: 631-563-7718
Mailing address:
  • Phone: 631-563-6205
  • Fax: 631-563-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number157514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: