=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083843601
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY ROMIWA EBEH LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2009
-----------------------------------------------------
Last Update Date | 07/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 796H DREW ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11208-4704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-235-3100
-----------------------------------------------------
Fax | 718-277-0822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10436 210TH ST
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11429-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-736-6170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 078805
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------