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General NPI Number Information
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NPI Number | 1639336589
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Entity Type | Organization
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Legal Business Name | EBC HEALTH
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 135 PARK BLVD
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-3643
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Country | US
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Telephone | 516-524-0665
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Fax |
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Provider Business Mailing Address
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Address Line | 209 FILLMORE ST
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-1513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRENDAN J KEYS SR.
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Credential | NP
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Telephone | 516-524-0665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F334247
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License Number State | NY
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