Provider Demographics
NPI:1245388776
Name:BANAS, EBY LUDERA (MD)
Entity Type:Individual
Prefix:DR
First Name:EBY
Middle Name:LUDERA
Last Name:BANAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3099
Mailing Address - Country:US
Mailing Address - Phone:856-354-1568
Mailing Address - Fax:856-354-1563
Practice Address - Street 1:1 MAINE AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3099
Practice Address - Country:US
Practice Address - Phone:856-354-1568
Practice Address - Fax:856-354-1563
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA381582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0409103Medicaid
NJ0409103Medicaid
D06283Medicare UPIN
DEAAB9638125OtherFEDERAL