Provider Demographics
NPI:1225596505
Name:TUDOR, EBONIE KARMA
Entity Type:Individual
Prefix:
First Name:EBONIE KARMA
Middle Name:
Last Name:TUDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARMA
Other - Middle Name:
Other - Last Name:TUDOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1123
Mailing Address - Country:US
Mailing Address - Phone:917-774-9235
Mailing Address - Fax:
Practice Address - Street 1:100 PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1123
Practice Address - Country:US
Practice Address - Phone:917-774-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty