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General NPI Number Information
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NPI Number | 1083243505
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Entity Type | Individual
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Provider Name | JERKY EBAI MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 55 FRUIT ST
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City | BOSTON
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State | MA
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Zip | 02114-2696
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Country | US
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Telephone | 617-724-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 8055 MAYFIELD RD STE 105
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City | CHESTERLAND
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State | OH
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Zip | 44026-2447
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Country | US
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Telephone | 440-214-8026
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Fax | 216-201-7963
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.153447
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License Number State | OH
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