Provider Demographics
NPI:1144423971
Name:ENIN, EBENEZER (RN)
Entity Type:Individual
Prefix:MR
First Name:EBENEZER
Middle Name:
Last Name:ENIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4126
Mailing Address - Country:US
Mailing Address - Phone:631-772-8652
Mailing Address - Fax:
Practice Address - Street 1:67 PALMETTO DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4126
Practice Address - Country:US
Practice Address - Phone:631-772-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY522482163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse