Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | X006299 | NY |
NPI | 1194934687 |
---|---|
Provider Name | Dr. Michael Ebbro |
First Address | New York, NY 10016-3256 |
Second Address | New York, NY 10016-3256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |