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General NPI Number Information
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NPI Number | 1861816175
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Entity Type | Organization
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Legal Business Name | EKB CONSULTING LLC
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 328 COMMONWEALTH AVE
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City | NEW BRITAIN
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State | CT
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Zip | 06053-2408
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Country | US
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Telephone | 203-901-2890
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Fax | 855-885-4079
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Provider Business Mailing Address
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Address Line | PO BOX 2009
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City | SHELTON
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State | CT
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Zip | 06484-1009
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Country | US
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Telephone | 203-901-2890
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Fax | 855-885-4079
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. EMMANUEL KENTA-BIBI
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Credential | M.D.
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Telephone | 203-901-2890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 047740
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License Number State | CT
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