Provider Demographics
NPI:1083916720
Name:LOVE, EBONY LASHAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:EBONY
Middle Name:LASHAY
Last Name:LOVE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22433
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2433
Mailing Address - Country:US
Mailing Address - Phone:215-777-5808
Mailing Address - Fax:215-777-5716
Practice Address - Street 1:148 N 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2418
Practice Address - Country:US
Practice Address - Phone:215-777-5808
Practice Address - Fax:215-777-5825
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001150213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003118774AMedicaid
GA511G700902OtherGROUP MEDICARE PTAN
GA202I481075OtherINDIVIDUAL MEDICARE PTAN